Yes. A State is not required to select the same EHB benchmark reference plan for Medicaid section 1937 plans that it selects for the individual and small group market, and it could have more than one EHB benchmark reference plan for Medicaid (for example, if the State were to develop more than one benefit plan under section 1937).
Since 2006, State Medicaid programs have had the option to provide certain groups of Medicaid enrollees with an alternative benefit package known as "benchmark" or "benchmark-equivalent" coverage, based on one of three commercial insurance products or a fourth, "Secretary-approved" coverage option. Beginning on January 1, 2014, all Medicaid benchmark and benchmark-equivalent plans must include at least the ten statutory categories of Essential Health Benefits.
Yes. CMS will continue to consider section 1115 demonstration extension requests. However, the State's proposal must include a plan to address changes in its demonstration that would need to take place to ensure readiness for 2014.
The SOTA calls cannot replace the submission of a transition plan, as the plan is a required deliverable under the State's Special Terms and Conditions. However, we expect to use the SOTA calls as a platform for transition planning discussions. We are also available for additional calls with States as needed. We can accept as the State's required early deliverable, a summary of the issues that the State needs to address in the transition plan, given the specific features of its waiver and plans for 2014.
CMS plans to provide technical assistance on transition plans to States through the State Operations and Technical Assistance Team (SOTA) calls and through other calls with the State. We will also be providing additional guidance about the information that should be included in the transition plans. We will consider the transition plans that need to be submitted by the due date as living documents that are open to revision, and will continue to work with States to ensure a seamless transition in 2014 for beneficiaries and States.
The section 1115 waiver authority continues and whether a particular waiver continues will vary by State. CMS has been working with States individually to determine the appropriate waivers and expenditure authorities that will be extended beyond December 31, 2013. For example, States that have utilized demonstrations to expand eligibility to the childless adult population will no longer need the expenditure authority because this population will become a mandatory State plan population under the Affordable Care Act's Medicaid eligibility expansion.
The Correspondence Log is the official record for the package. The Correspondence Log can be used as a communication tool, where CMS provides information to the state and the state can respond. Only the SPOC and the CMS Point of Contact can write in the correspondence log, but others may view the correspondence log in a package for reference.
