States have the option to provide benefits specifically tailored to meet the needs of certain Medicaid population groups, target residents in certain areas of the state, or provide services through specific delivery systems. These benefit packages are referred to as “benchmark coverage” or “benchmark-equivalent coverage.”
Eligibility for Benchmark Benefits
States can generally choose which groups of people they will enroll in a benchmark/benchmark-equivalent benefit plan, but certain populations defined in statute are exempt from mandatory enrollment in a benchmark plan.
States can offer voluntary enrollment in a benchmark/benchmark-equivalent benefit plan to these exempt populations, but cannot require it.
Health Benefit Packages that Qualify as Benchmark Benefits
- Federal Employees Health Benefit Plan Coverage (FEHBP Health Insurance Coverage)
- State Employee Health Benefit Coverage
- The Health Maintenance Organization (HMO) plan that has the largest insured commercial, non-Medicaid enrollment in the state.
- Secretary-approved coverage: Any other health coverage that provides appropriate coverage for the population covered by the Benchmark benefit plan as determined by the Secretary, and Benchmark-equivalent coverage that is actuarially equivalent to one of the 3 specified benchmark plans.
Benchmark Benefits for New Medicaid Enrollees
The Affordable Care Act of 2010 expands Medicaid to individuals with family incomes up to 133% of the Federal Poverty Level ($14,484 for an individual in 2011) as of January 2014 but States can choose to expand coverage prior to this date. The law requires states to enroll newly eligible people in benchmark or benchmark-equivalent benefit plans.