Enhancing Essential Health Benefits: How States Are Updating Benchmark Plans to Improve Coverage.

Issue: To address longstanding gaps in coverage, the Affordable Care Act requires individual and small-group health insurance to cover an essential health benefits (EHB) package. States define the exact scope of these benefits within federal parameters by designating a "benchmark" plan. Federal rules effective in 2020 and 2026 give states additional flexibility to update EHB benchmark plans. Goal: To understand the goals and experiences of states that have updated their EHB benchmark plan since 2020. Methods: We analyzed benchmark plan documents from the 11 states that, along with the District of Columbia, have received federal approval for benchmark updates since 2020. We interviewed officials in eight of these states. Key Findings: States have added benefits to address consumers' needs or advance state health policy goals. States generally relied on federal funding, benefited from federal technical support, and viewed recent federal rule changes as helpful. States face ongoing challenges to ensure required benefits keep pace with advances in science and medical evidence. Conclusion: While some states have updated their EHB benchmark plans to increase consumers' access to essential services, it is ultimately the federal government's responsibility to identify and close gaps in essential health benefits. [ABSTRACT FROM AUTHOR]