CMS Finalizes Rule To Allow States To Offer Alternative Medicaid Benefits Packages

Main Category: Medicare / Medicaid / SCHIP
Article Date: 04 Dec 2008 - 2:00 PDT

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CMS will publish a final rule in the Dec. 3 Federal Register that would allow states to choose to offer alternative benefits packages that differ from the standard Medicaid benefits package to certain Medicaid populations -- including women and families -- a step critics say could restrict coverage of important services, BNA reports. The rule, which was proposed in February and takes effect 60 days after publication, implements provisions of the 2005 Deficit Reduction Act. CMS has said the benchmark models for benefit packages include the standard Blue Cross Blue Shield PPO under the Federal Employees Health Benefit Plan, state employee coverage, coverage under each state's largest commercial HMO or coverage approved by CMS through a state plan amendment. CMS in the final rule said that its requirements "were designed to maximize state flexibility while assuring that beneficiaries will get quality care that meets their needs." The agency said the rule would create $2.3 billion in savings over five years through the use of the alternative benefit plans, known as benchmark benefit packages or benchmark-equivalent packages.

The rule has attracted criticism from many groups, which argue that poorly designed benefits packages could cut beneficiaries' access to services. CMS said it received more than 1,100 comments on the draft versions, most of which were in opposition to the rule. A coalition of more than 20 organizations -- including Families USA, the Association for Community Affiliated Plans and the Children's Defense Fund -- said in its comments to CMS that Medicaid waivers allowing states to experiment with the benchmark-equivalent packages have "led to packages that lack vital services, such hospital care, specialist care, mental health coverage and substance abuse treatment." Some comments also expressed concerns that changes in benefits packages could limit coverage for family planning services, BNA reports. CMS said that the rule is "consistent with congressional intent" and that critics should direct further concerns to the states, which will determine whether to implement new benefits packages (BNA, 12/3).

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