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Benefits

The Affordable Care Act makes various changes to the benefits provided to Medicaid enrollees. Additionally, people newly eligible for Medicaid will receive a benchmark benefit or benchmark-equivalent package that includes the minimum essential benefits provided in the Affordable Insurance Exchanges. See more information about Medicaid benefits.

Areas of interest under this provision:

  • Benchmark Benefit Plans
  • Prescription Drugs
  • Tobacco Cessation Services for Pregnant Women
  • Family Planning
  • Hospice Care for Children
  • Tobacco Cessation
  • Preventive and Obesity-Related Services
  • State Option to Provide Health Homes for Enrollees with Chronic Conditions

 

Benchmark Benefit Plans: Assuring that the coverage gained through the Medicaid eligibility expansion includes mental health services and prescription drugs.

Prescription Drugs: Changing the Medicaid prescription drug program by revising the definition of average manufacturer price (AMP), establishing a new formula for calculating the federal upper limit (FUL), increasing the rebate percentages for covered outpatient drugs, and extending the rebates to drugs dispensed to enrollees in managed care organizations. Also, preventing states from excluding tobacco cessation drugs from coverage, beginning in 2014.

Tobacco Cessation Services for Pregnant Women: Providing comprehensive tobacco cessation services for pregnant women without cost-sharing.

Family Planning: Establishing a new Medicaid eligibility group and the option for states to begin providing medical assistance for family planning services and supplies.

Hospice Care for Children: Assuring that children can receive curative treatment upon the election of the hospice benefit for children enrolled in Medicaid or the Children's Health Insurance Program (CHIP).

Tobacco Cessation: Providing Medicaid coverage of tobacco cessation services, including counseling and pharmacotherapy, to pregnant women as recommended by the 2008 Public Health Service (PHS) Clinical Practice Guidelines.

Preventive and Obesity-Related Services: Allowing states to cover specified preventive services at no cost to Medicaid adult enrollees. (Children are already entitled to preventive services under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit).

State Option to Provide Health Homes for Enrollees with Chronic Conditions

The Affordable Care Act of 2010, Section 2703, created an optional Medicaid State Plan benefit for states to establish Health Homes to coordinate care for people with Medicaid who have chronic conditions by adding Section 1945 of the Social Security Act. CMS expects states health home providers to operate under a “whole-person” philosophy. Health Homes providers will integrate and coordinate all primary, acute, behavioral health, and long-term services and supports to treat the whole person.  More information on Health Homes.