Under the Affordable Care Act, the Medicaid expansion population that became eligible on January 1, 2014 must be provided benchmark benefits consistent with section 1937 of the Social Security Act. State Medicaid agencies must designate, as part of their 2014-related State Plan changes, one or more of the following plans or their actuarial equivalent as an essential health benefits (EHB) benchmark reference plan:

  1. The standard Blue Cross/Blue Shield Federal Employee Health Benefit Plan (FEHBP);
  2. Any generally available state employee health plan available in the state concerned;
  3. The largest insured commercial, non-Medicaid health maintenance organization (HMO) in the state; or
  4. Any other benefits approved by the Secretary of Health and Human Services (HHS) that provides appropriate coverage for the population to be served.

After cataloguing the benefits offered in state-specific plans, states may use the following planning tool to compare benefits between the applicable potential Medicaid benchmark plans within the 10 EHB categories. When making this comparison, states should keep in mind what benchmark benefits are being considered for the health benefits exchange. CHCS developed this state technical assistance tool for the Robert Wood Johnson Foundation’s State Health Reform Assistance Network.