California has lodged a formal application with federal authorities to update its benchmark plan for essential health benefits (EHBs), which could include a wider array of services like in vitro fertilization (IVF), hearing exams, and durable medical equipment. Governor Gavin Newsom announced the application today, submitted to the Centers for Medicare & Medicaid Services (CMS), aiming to implement these changes by 2027, as reported by the Governor's Office.
The enhancements to the state's EHBs are envisioned to universally ensure Californians access to necessary health care, including fertility treatments and aids for individuals with hearing and mobility challenges. Governor Newsom said, "Quality health care should be available for all Californians, and one way we are working to achieve this goal is by updating the state’s benchmark plan for required health benefits." He underscored the previous year's collaborative efforts with the Legislature to achieve these potential improvements, outlining the proposed impact on millions in the state.
California’s Senate and Assembly Health Committee chairs showed unified support for the administration's push. Senator Caroline Menjivar commended the progress, highlighting the profound difference it could make for Californians with disabilities and those facing infertility. According to an interview published on the Governor's Office website, Senator Menjivar stated, "The new proposed benchmark plan means children who are hard of hearing or deaf will have coverage for the hearing aids that make a significant difference in their development and well-being." In addition, Assemblymember Mia Bonta emphasized the collective effort and anticipated daily impact of the proposed changes for Californians.
The breadth of support carried through to the California Health & Human Services Agency, with Secretary Kim Johnson praising the initiative for closing gaps and enhancing access to pivotal health services. Following a diligent evaluation process, DMHC Director Mary Watanabe extended thanks to all contributors from various sectors of health and public domains. She remarked on the importance of communal input, stating, "This input has been essential, and was carefully considered, as we examined new opportunities to improve and expand health care coverage requirements under a new benchmark plan."
The state's action aligns with Affordable Care Act mandates, which compel individual and small group market plans to offer services encompassing broad categories such as primary care, emergency services, and prescription drugs. California's draft benchmark plan emerged through a series of public deliberations and comment periods documented by the DMHC. If approved by CMS, these new requirements would be set to kick in starting January 1, 2027, potentially revolutionizing access to EHBs for Californians.
