EHB categories don’t measure up with Medicaid and CHIP

December 14, 2012

Interesting report by the American Academy of Pediatrics (AAP) published in August that compared coverage and costs for each of the 10 EHB categories currently offered by the three largest federal employee health plans, one of the largest state employee plans and one of the largest small group plans in five states. For these states—Alabama, Colorado, Maryland, Texas and Washington—the report also compared coverage under the Children’s Health Insurance Program (CHIP) and Medicaid. Most significantly, none of these plans approached the breadth of coverage and cost-sharing protection available under Medicaid or the states’ separate CHIP plans. Whoa! If the EHB is the benchmark for what gets covered we could be in a world of hurt. Network faithful who have been following this discussion on the website know that we are very concerned about the potential for essential benefits coverage being limited to the point of eroding quality of service – which paradoxically leads to higher costs. This report appears to confirm our fears. Gotta pay attention folks. Decisions are being made now that will have long lasting impact on children and families. Get involved with your state health exchange!

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