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maxenroll Bachrach 033011.pdf - National Academy for State Health ...

maxenroll Bachrach 033011.pdf - National Academy for State Health ...

Cost SharingBeyond

Cost SharingBeyond covered services, the ACA provides incentives for states to align consumer cost-sharingrequirements for preventive services between Medicaid and private coverage. Starting in 2013, theACA provides that Medicaid programs cover preventive services and immunizations for adults. TheACA further provides that the federal government will pay an additional one percent of the cost ofpreventive services if states eliminate consumer cost sharing for these services. 39 For these sameservices, the ACA mandates that in plan years beginning on or after September 23, 2010, all privateinsurers, including QHPs in the Exchange, provide coverage without consumer cost sharing. 40 Inaddition to accessing increased federal funding, states that eliminate consumer cost-sharing forpreventive services in Medicaid would provide consistency and transparency of benefits across thecontinuum of coverage for consumers.Benefit PackageSummaryIssuesState Exchanges will offer a continuum of health insurancecoverage options, and states will be charged with developingbenefit packages – consistent with federal guidance – acrossthe continuum of coverage. The ACA mandates a “benchmarkbenefit” for consumers who are newly eligible for Medicaidthrough expansion of the program in 2014. The law alsorequires an “essential benefit package” that must be providedby QHPs participating in the Exchange.States have financial, administrative and seamlessnessconsiderations in defining benefits across the continuum ofcoverage that will be available in 2014.39 ACA § 4106. Health Affairs Health Policy Brief "Preventive Services Without Cost Sharing," December 28, 2010. 40 ACA § 1001 [PHSA § 2713]. This requirement does not apply to "grandfathered" plans. Federal Register: Group Health Plans and Health Insurance coverage Rules Relating to State as a Grandfathered Health Plan Under the Patient Protection and Affordable Care Act; Interim Final Rule and Proposed Rule. Vol. 75, No. 116/Thursday, June 17, 2010. pp. 34571-­‐34572. Available at: http://edocket.access.gpo.gov/2010/pdf/2010-­‐14488.pdf. Medicaid’s Role in Exchanges -25

Decision PointsFor States:Should the benchmark benefit be a minimal package tominimize state financial obligations?Would a more robust benchmark benefit maximize federalfunding for state Medicaid programs, and reduce current statefunding levels for spend-down Medicaid beneficiaries?Should states seek to provide a uniform benefit package for allcommunity-based Medicaid consumers from 0-139 percentFPL? What are the fiscal pros and cons of doing so? What arethe administrative pros and cons of doing so?Should states seek to ensure alignment of the Medicaidbenchmark benefit with the essential benefit offering toconsumers eligible for private coverage in the Exchange?Should states eliminate cost sharing for preventive services inMedicaid?For the Federal Government:To the extent that the essential benefit package includes mentalhealth and chemical dependence services provided by IMDs,will federal matching dollars be available for these servicesMedicaidʼs benchmark benefit?Medicaid’s Role in Exchanges -26

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