Center for Medicare and Medicaid Services

Description

We know it can be challenging for states to fund the work necessary to improve the Essential Health Benefits (EHB). Improving EHB typically involves: Comprehensively reviewing EHB-benchmark plans. Seeking public feedback on the coverage of EHB in the state. Submitting an application to CMS to change the EHB in the state. We understand that, due in part to these challenges, that there are many states that have not considered updating their EHB-benchmark plans. These states include 24 of the 28 states expected to have a Federally-facilitated Exchange (FFE) as of January 1, 2026. As a result, the covered benefits in the Qualified Health Plans (QHPs) offered through the Exchanges in these states may not reflect recent changes in medical evidence, scientific advancement, and clinical care guidelines. Additionally, people enrolled in these QHPs may have trouble accessing EHB because of cost, claims denials, utilization management, discriminatory benefit design, or other factors. We want to lessen these challenges through the EHB-Benchmark Plan Modernization Grant for States with a Federally-facilitated Exchange (FFE EHB Mod Grant). This new grant program will fund states with an FFE for a variety of activities related to the review of EHB-benchmark plans. The goal is to help applicants modernize and change their EHB-benchmark plans under 45 CFR 156.111.

Who can apply

• State governments

Contact

PMPolicy@cms.hhs.gov
PMPolicy@cms.hhs.gov