One of the primary features of the Affordable Care Act was the establishment of marketplace health insurance plans that folks can buy – with most qualifying for subsidies scaled to income to make the plans affordable.
While the math for the subsidies was set by the feds, the coverage those plans offer in each state were a hybrid of criteria set by the feds (the 10 essential health benefits). Governors have some influence too, as they get to select a ‘benchmark plan’ that defines minimum benefits in each essential health benefit category.
Back in 2014, Governor Brewer picked the AZ State Employee ‘EPO’ Plan as the benchmark for Arizona’s Marketplace plans. Ever since then, Marketplace plans have needed to cover (at a minimum) the same benefits as the state employee plan.
Other commercially available plans need to be “substantially equal” to the state employee benchmark plan in scope, limitations, and exclusions (e.g. visit limits).
At the time, I opined on my ADHS Blog that the choice was a good one because it had a robust behavioral health component with fewer limitations, restrictions and exclusions than most other options- and already covers behavioral health services at parity (meaning behavioral health has the same level of coverage as physical health).
To my knowledge, the Ducey administration never made any changes to that benchmark plan.
Hobbs Proposing Changes
Last week Governor Hobbs issued an Executive Order that makes over-the-counter birth control options available at no cost to State employees, ordering an analysis of the costs & benefits of requiring expanded contraception coverage for other health insurance plans, and requiring AHCCCS to consider ways it can expand access to contraception for its members.
See: Katie Hobbs issues executive order expanding access to contraception
Buried in the Executive Order, but getting little fanfare, was a provision that directs ADOA and the Department of Insurance & Financial Institutions to examine the benchmark plan established in 2014 and look at the benefits & feasibility of setting a new benchmark plan that would mandate provision of additional reproductive healthcare benefits among commercial and marketplace insurance plans in AZ.
AHCCCS has been tasked with a similar charge – to examine benefits and feasibility of expanding Medicaid benefits among a host of reproductive health criteria (by June 30, 2024).
Because the ACA is federal legislation and the law gives governors the authority to set minimum coverages by establishing a benchmark plan, her action won’t need legislative approval. AHCCCS would need approval from CMS to extend reproductive health benefits.
Note: The Order is limited to examining Arizona’s essential health benefits through the lens of reproductive health.
