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Essential Health Benefits: Where Are States Now?

September 30th marked the deadline for states to choose their essential health benefit (EHB) benchmark plan. To date, the 23 states and the District of Columbia that have made a preliminary benchmark plan recommendation are: Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Kentucky, Maryland, Massachusetts, Michigan, Mississippi, Nebraska, New Hampshire, New Mexico, New York, North Dakota, Oregon, Rhode Island, Utah, Vermont and Washington. Of states not selecting a benchmark plan before the deadline, the 11 states awaiting further federal guidance before choosing a benchmark plan are: Alabama, Florida, Indiana, Iowa, Louisiana, Ohio, Oklahoma, Pennsylvania, Tennessee, West Virginia and Wisconsin.  The remaining states have remained silent on benchmark plan selection.

The official rule from the US Department of Health and Human Services (HHS) detailing plan selection, benefit design and mandates, among other things, is not expected until after the election. HHS has said that if a state has not selected a plan by the deadline, the default plan (largest small group plan based on enrollment) would be used.

Information about the state plan decisions, including details about plan type (small group, state employer, etc.) can be found on the State Refor(u)m tracking site. All recommendations are pending federal review and may require supplemental benefits to meet the Affordable Care Act (ACA) guidelines.

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