Medicaid Benchmark Coverage Health Reform

Medicaid Benchmark Benefits in Health Reform: Improvements and Exemptions November 2010 On January 1, 2014, Medicaid will expand to cover an estimated 17.1 million Americans who are currently 1uninsured. The Affordable Care Act of 2010 (ACA) requires that most of these newly enrolled individuals be entered into benchmark plans, which have traditionally been less comprehensive than standard Medicaid coverage. However, the ACA also mandates several important improvements to benchmark coverage. This fact sheet outlines the current differences between benchmark and standard coverage, describes the improvements to benchmark coverage under health reform, and explains which groups of newly covered individuals will be exempt from enrolling in benchmark plans. Mental Health and Substance Use Disorder Coverage in Standard vs. Benchmark Plans Standard Medicaid benefits include a wide array of mandatory and optional services. Mental health and substance use (MH/SU) treatment services are not mandated benefits; however, many such services are covered under the mandatory categories of physician and hospital services or the optional categories of prescription drug coverage, rehabilitation, and targeted case management. Benefits under standard Medicaid must have minimal levels of cost-sharing for beneficiaries, and states are limited in their ability to impose restrictions on the duration or scope of services. The Deficit Reduction Act of 2005 gave states the ...