Ohio opts for default ACA essential health benefits list

The Kasich Administration did not meet a deadline this week to establish the minimum health insurance benefits that Ohioans will be entitled starting in 2014 as part of the Affordable Care Act (Source: "Ohio misses health-care deadline," Columbus Dispatch, Oct. 4, 2012).

Lt. Gov. Mary Taylor, who also serves as director of the Ohio Department of Insurance, wrote in a letter to federal officials that a lack of information and guidance from the Department of Health and Human Services hampered the state's ability to set its list of "essential health benefits."

In December 2011, the HHS issued a bulletin signaling its intent to allow states to determine individually the benchmark set of essential health benefits for plans sold in their state. However, in a letter to HHS Secretary Kathleen Sebelius, Taylor wrote that “the bulletin falls short of meeting states’ real needs for clarification, guidance and interpretation and cannot substitute for the authority of the rule. "

If a state does not choose a benchmark, the largest small group plan will serve as the default. In the future, states will have to select an EHB benchmark plan in the third quarter two years prior to the coverage year, based on enrollment from the first quarter of that year.

In August, HPIO released "An introduction to 'essential health benefits': Ohio's role in determining services covered by insurance post-2014," (pdf, 6 pages) that details the issue.