The Affordable Care Act not only expanded opportunities for previously uninsured individuals to access coverage; it also ensured that such coverage was comprehensive. Essential Health Benefits (EHBs) are a set of basic benefits that all non-grandfathered individual and small-group market plans and all Medicaid expansion plans must cover. The EHB coverage requirement has helped close significant coverage gaps in areas such as maternity and newborn care, mental health and substance use disorders, and rehabilitative and habilitative services and devices. It also represents an important health equity tool to address health disparities among BIPOC, LGBTQI+ individuals, and people with disabilities.
Despite the gains achieved, significant gaps in access to certain services remain, and wide variability in coverage requirements exists from state to state. To address those gaps, the Services Practice Area advocates at the federal level for adoption of uniform and minimum standards of coverage for different categories of EHBs. We also advocate for comprehensive guidance from the federal government to help states enforce EHB coverage requirements and non-discrimination in benefit design, which ensures that EHB coverage reflects the needs of underserved populations. Similarly, we advocate at the state level and provide legal analysis, educational materials, and technical assistance to advocates and policymakers in states seeking to expand access to specific services through the EHB benchmarking process.
