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Patchwork State Coverage for Pediatric Essential Health Benefit

Last Updated: December 15, 2014.

A state-by-state benchmark plan approach results in a patchwork of coverage for the Affordable Care Act's pediatric essential health benefit, according to research published in the December issue of Health Affairs.

MONDAY, Dec. 15, 2014 (HealthDay News) -- A state-by-state benchmark plan approach results in a patchwork of coverage for the Affordable Care Act's (ACA) pediatric essential health benefit, according to research published in the December issue of Health Affairs.

Under the ACA, "pediatric services" is one of the required classes of coverage, and the pediatric benefit standard employs a state-by-state benchmark plan approach. With this in mind, Aimee M. Grace, M.D., from the Children's National Health System in Washington, D.C., and colleagues examined how the state benchmark plans address pediatric coverage.

In a review of summaries of all state benchmark plans, the researchers found that none of the states specified a distinct pediatric services benefit class. Many plans specifically excluded services for children with special health care needs, although benchmark plans specifically included multiple pediatric conditions.

"The ACA includes important benefits for children and significant opportunities that have not yet been fully realized," the authors write. "These findings demonstrate a missed opportunity by the U.S. Department of Health and Human Services to strengthen pediatric benefits under the ACA's essential health benefits standard."

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