Benchmark Plans Tailored Benefits

Health and Human Services Commission Medicaid Reform Strategies for Texas Strategy Benchmark Plans (Tailored Benefits) Background: The Deficit Reduction Act 2005 (DRA) gives states the option, through a state plan amendment process, to provide alternative benefits packages to beneficiaries. These plans, called “benchmark plans,” are similar to those allowed under the State Children’s Health Insurance Program (SCHIP). “Benchmark” coverage options include the standard Blue Cross Blue Shield plan offered under the Federal Employee Health Benefit Plan, health coverage provided to state employees, or the health coverage offered by the largest commercial HMO in the state. A state could also propose any other plan that would have to be approved by the U.S. Department of Health and Human Services (HHS). Categories of individuals that can be required to enroll in an alternative plan are generally limited to healthy adults and children. Categories of individuals that are exempt and may not be required to enroll in an alternative benefit plan include: mandatory pregnant women, blind or disabled individuals, dual eligibles, terminally ill hospice patients, those eligible on basis of institutionalization, medically frail and special needs populations (to be defined by Secretary of HHS), individuals qualifying for long term care services, children in foster care receiving child welfare services and children receiving foster care or adoption assistance, people ...