[{"_1":2,"_124":-5,"_125":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76,88,100,112],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6667391,"mediaKeyId","2264085-db56d023f6014199baa73eb8c84d4f3d","parentId",2264085,"title","Covered California and CHBRP warn EHB expansion could raise premiums as federal subsidies remain uncertain","audioSeconds",4006,"startMs",7286000,"endMs",11292000,"viewUrl","/Search/View?dp=1&key=2264085-db56d023f6014199baa73eb8c84d4f3d&start=7286&end=11292","thumbnailUrl","https://assets.pipeline.soar.com/2264085-db56d023f6014199baa73eb8c84d4f3d/thumbnail_7286000.jpg","articleUrl","/articles/6667391/California/Covered-California-and-CHBRP-warn-EHB-expansion-could-raise-premiums-as-federal-subsidies-remain-uncertain","mediaUrl","https://secure.pipeline.soar.com/6667391-dc137ef90588d09f2e8e9966bead82d2/orig.mp4?Expires=1771160264&Signature=hWZgnYabJBdt1tdO3R7xOwJBeCjDkgwwHFFHcBR1k58g9u~4zLoz-Ys9nKB0ksxtt6CG4yDlA5dzJZp5euhNHdHc-Bn6Rbho0i8v-n~IbqXsnJUFvVx7edMbm5EA05GS8poXS9pe5fMlqaJXECH5ftkRvktrvsyFsheggf3aDXyaMc90pUiILruoEPlLSAHsjNlEzL9Tvidz6jnf9iCo9qDHrTEIh0W35xCJoM9Vdg6dQPo96I-Ldddos2ZjxT~tQwYBWCm0Sewjci4v63F0exSQ3yQwUTH~LkSW6ypah-rMntH7QoPwtPqg8OHzHmexrwQsP3jHVc7AqWGLZhqumw__&Key-Pair-Id=KUT5TJCACFTXG","author","California State Senate","date","2025-02-11T00:00:00Z","article","Two panels at the joint Assembly and Senate health hearing focused on premium impacts and market implications of adding benefits to California’s EHB benchmark.

Why it matters: Covered California insures nearly 2 million consumers and most enrollees receive federal premium assistance; even modest premium increases can reduce enrollment, change the risk pool and raise premiums further.

CHBRP findings: Darren Corbett of the California Health Benefits Review Program summarized a two‑week CHBRP analysis intended to be expedient. CHBRP produced silver‑plan PMPM illustrative estimates: hearing aids at about $1.52 PMPM; wigs/cranial prosthesis about $0.31 PMPM; chiropractic about $0.78 PMPM; DME (including CPAP and mobility aids) around $1.64 PMPM; augmented communication devices $0.03 PMPM; neuromodulators $0.01 PMPM; and infertility (CHBRP’s SB 729 scenario) $5.36 PMPM. Corbett cautioned the figures assume no baseline coverage and do not model how subsidies or changes in enrollment might alter premium impacts.

Covered California perspective: Doug McKeever, chief deputy executive director for programs at Covered California, framed the discussion through affordability and access. He told the committee Covered California had not yet modeled the issuer‑level premium impacts for the candidate benefit packages: \"As of today, we have not done an assessment financially of what the premium impact will be if, any or all of the considered benefits are included.\" McKeever warned that federal enhanced subsidies are scheduled to expire and that reductions in federal assistance would push many consumers to drop coverage; he and staff said loss of subsidies could produce large enrollment declines (Covered California has estimated possible loss of up to ~400,000 enrollees if enhancements expire) and steep premium increases for different income groups.

Policy tradeoffs: Covered California staff stressed the combination of subsidy uncertainty and any premium increase from EHB expansion could disproportionately affect lower‑income and communities of color. McKeever recommended careful balancing: coverage gains versus consumer affordability and exchange stability.

Unresolved items and next steps: Committee members asked whether the state could use existing state funds to offset premium increases. Covered California said any state fund would be insufficient to replace federal subsidies and that state funds could help mitigate premium increases only if federal assistance remained in place. Covered California and CHBRP urged more time for issuer‑level rate modeling; both said such modeling takes additional time beyond the tight May filing window.

Ending: The agencies recommended the Legislature factor federal subsidy uncertainty into any decision to expand EHBs and to seek additional actuarial detail and insurer rate models before selecting a final package for a CMS filing.","mediaType","Video","parentTitle","California State Senate - Joint Hearing Senate Health Committee And Assembly Health Committee - Feb 11, 2025","oneSentenceSummary","Presentations from the California Health Benefits Review Program and Covered California highlighted estimated per‑member premium impacts for candidate benefits and warned that loss of federal premium subsidies would compound consumer cost increases and cause enrollment declines.","taxTitle","California State Senate, Senate, Legislative, California","taxId",77650,"location","California","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6667395,"Durable medical equipment, cranial prostheses and chiropractic services among benefits priced in EHB review",7034,4369000,11403000,"/Search/View?dp=1&key=2264085-db56d023f6014199baa73eb8c84d4f3d&start=4369&end=11403","https://assets.pipeline.soar.com/2264085-db56d023f6014199baa73eb8c84d4f3d/thumbnail_4369000.jpg","/articles/6667395/California/Durable-medical-equipment-cranial-prostheses-and-chiropractic-services-among-benefits-priced-in-EHB-review","https://secure.pipeline.soar.com/6667395-3f263a0492c641d227be0e1526c39e14/orig.mp4?Expires=1771160264&Signature=kI~2CbDLaTpyd5jiJmcA2farypIsyZvJEKUsC-dJtFR2a00xSXcsimIBl9IS~sS22FOAGPsin0g4tyVnHTITp~dxMRWrIajDXiyf43jdaxuj3P9M5WouWvYvpgl~NPWQZmIccIigbOwaUnu4jrtbp8XMs-utTGOaJ7lC-JX2c05BG4-67nLnQr7KefO6AKnVp5V-hOoCRZpfS2uLxVFXIGyWx8D6yO~l1w2x9ezzHvHjGlRIY7KrLtXW8siAUTauzabc-Vb9Zru8ylZz6ZP5hY1~7TLUC~tri6C-OOswm9~Q8b82kNA9cEjFcuBOmKNyfhoG2mLtfZFRLhQ5kuyoyQ__&Key-Pair-Id=KUT5TJCACFTXG","The informational hearing on California’s EHB benchmark included detailed pricing for three categories of benefits frequently raised in stakeholder comment: durable medical equipment (DME), cranial prostheses (wigs/hairpieces) and chiropractic care.

Why it matters: Adding DME, cranial prosthesis and chiropractic care would require minimum benefit definitions and actuarial justification and would affect plan allowed costs and member premiums in individual and small‑group markets.

What the actuaries said: Wakely said DME pricing is driven by specific items — for example, CPAP machines represented a major share of the DME cost estimates — and that wheelchair and powered mobility device unit costs vary widely. In Wakely’s breakout, the DME total had a wide range because some high‑cost items have low utilization while others have broader use. Wakely priced cranial prosthesis (wigs/hairpieces) across a range of unit types from synthetic to high‑end human‑hair units and noted a wide unit‑cost variance; the firm had priced a single wig per year as an illustrative option. For chiropractic care, Slaughter noted the comparison benchmark plans varied in visit limits; his tally of the ten CMS benchmark options showed chiropractic coverage was one of the items that made some plans richer in the typicality comparison.

CHBRP estimates: CHBRP provided illustrative silver‑plan PMPM estimates for some categories: the program estimated adult wigs/cranial prosthesis at about $0.31 PMPM and chiropractic coverage at $0.78 PMPM; CHBRP estimated a DME category (including CPAP, walkers and wheelchairs) at about $1.64 PMPM. CHBRP noted assumptions include use of step therapy or prior authorization for high‑cost devices and that unit costs and utilization assumptions materially affect estimates.

Public testimony and equity concerns: Patient advocates urged coverage for cranial prosthesis for patients with cancer, alopecia, thyroid disease and burns. Several witnesses said prostheses are not cosmetic for individuals experiencing medically‑related hair loss and urged coverage that allows durable options for those who cannot afford high‑end pieces. Advocacy organizations and clinical witnesses also emphasized that insufficient DME coverage forces people into lower‑quality devices or publicly funded programs.

Outstanding issues: Committee members sought more granular lists of which specific DME items would be covered and clearer definitions for prosthesis frequency and quality (synthetic vs. real hair). Actuaries said more precise benefit definitions and issuer practices on utilization management would narrow the pricing ranges.

Ending: The hearing showed DME, cranial prostheses and chiropractic services are candidates for EHB expansion but that adding them all would exceed the actuarial room identified by Wakely. The committee directed staff to refine definitions and unit‑cost detail for future deliberations.","Consultants priced DME (including wheelchairs and CPAP), cranial prosthesis (wigs/hairpieces), and chiropractic care as candidate additions to California’s EHB benchmark; the total menu exceeds the state's actuarial room so the committee must prioritize additions.",{"_33":89,"_35":36,"_37":38,"_39":90,"_41":91,"_43":92,"_45":93,"_47":94,"_49":95,"_51":96,"_53":97,"_55":56,"_57":58,"_59":98,"_61":62,"_63":64,"_65":99,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6667398,"Parents and advocates press state to add hearing aids to EHBs after committee hears access gaps",6532,4642000,11174000,"/Search/View?dp=1&key=2264085-db56d023f6014199baa73eb8c84d4f3d&start=4642&end=11174","https://assets.pipeline.soar.com/2264085-db56d023f6014199baa73eb8c84d4f3d/thumbnail_4642000.jpg","/articles/6667398/California/Parents-and-advocates-press-state-to-add-hearing-aids-to-EHBs-after-committee-hears-access-gaps","https://secure.pipeline.soar.com/6667398-3eccbc2f4eaebda1997527f94d614839/orig.mp4?Expires=1771160264&Signature=iqYaEJj~nqy8yAIPSlGhd8JexalEQFj9oNd9xS3TlgjUV7gM41EJjKCC9BXMT0nKr~137uhmnqMXFVwe78cbpn~QRQ84epDv0WqSQ6NtUa1YneMxI0NKBmLZxrTduOcuvAv4oeh32hSbdHC307bxL4sYp7PWLgybyYFHtju84l~8iKQ0lrX3UPPWw7JzuCJZKPthd09rOpEbBlnUmMFy8XipVNvFjG0lWl8Xpl4ezrGGSUByxFk5q1W2yduBLdCfwvxfxL-L2vMUX8RLdYls1oPrD5ZqE07ttx67SLIT7CUnBGQzmT6VgGGZgEZDWVaTrPi-LmvgD5ZK4ccy5TvZZg__&Key-Pair-Id=KUT5TJCACFTXG","At a joint hearing on California’s essential health benefits benchmark, advocates, clinicians and parents urged the Legislature to add hearing‑aid coverage — especially for children — to the state benchmark plan.

Why it matters: Hearing aids are costly and, for children in critical language development periods, experts say lack of coverage can impair development and increase special‑education needs. If added to the EHB benchmark, hearing‑aid coverage would become a required benefit for plans in the individual and small‑group markets.

Evidence and estimates: Wakely actuary Matt Slaughter said that California’s current benchmark contains no hearing‑aid coverage. \"The hearing aids here, currently in the benchmark plan, there is no hearing aids covered,\" Slaughter said; he noted Wakely priced hearing aids in its menu and that the firm produced ranges for unit costs and utilization. CHBRP’s analysis included a silver‑plan PMPM estimate of about $1.52 for hearing aids. Wakely and CHBRP emphasized their estimates use different bases (allowed cost vs. premium impacts) and that both sets of numbers carry ranges driven by utilization assumptions.

Legal constraint: Agency counsel and actuaries noted CMS has said a benefit limited by age or condition can run afoul of its anti‑discrimination standard. Panelists said CMS has told other states that child‑only hearing aid coverage must be expanded to all ages if included in an EHB.

Public testimony: Parents and children described personal experiences: several families said hearing aids enabled meaningful development of speech and social interaction; a parent said her child’s speech and school participation improved after receiving devices. Advocacy groups, including Children Now and the California Academy of Audiology, urged addition of hearing aids and pointed to state special education costs linked to unaddressed hearing loss.

Unresolved items: Committee members asked DMHC and actuaries for more granular unit costs, issuer pricing and confirmation on whether pediatric‑only language would be acceptable to CMS; DMHC explained CMS’s recent guidance makes pediatric‑only language likely impermissible.

Ending: Advocates urged rapid action; agency staff cautioned the state must choose benefits that fit under the CMS typicality ceiling and provide defensible actuarial documentation if it pursues hearing‑aid coverage in a May filing.","Multiple parents, advocacy groups and clinicians urged legislators to include hearing aids — particularly for children — in the 2027 EHB benchmark. Actuaries said hearing‑aid coverage is not currently in California’s benchmark and would increase allowed costs; CMS rules prohibit age‑limited benefits.",{"_33":101,"_35":36,"_37":38,"_39":102,"_41":103,"_43":104,"_45":105,"_47":106,"_49":107,"_51":108,"_53":109,"_55":56,"_57":58,"_59":110,"_61":62,"_63":64,"_65":111,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6667400,"Lawmakers and patients press to add infertility and IVF to California’s essential health benefits",6517,4553000,11070000,"/Search/View?dp=1&key=2264085-db56d023f6014199baa73eb8c84d4f3d&start=4553&end=11070","https://assets.pipeline.soar.com/2264085-db56d023f6014199baa73eb8c84d4f3d/thumbnail_4553000.jpg","/articles/6667400/California/Lawmakers-and-patients-press-to-add-infertility-and-IVF-to-Californias-essential-health-benefits","https://secure.pipeline.soar.com/6667400-d09eb5c8a3615c65b5b52f51a41efe4c/orig.mp4?Expires=1771160264&Signature=QALIjBwKzOhSEEtfUlP-WCg8DZ1I0Rtoe-jNXaiSW3zvik5a8MfPPnDUX06nT5QJS-JjnBruvtuMPNb4RpbDbZ620x2TdlfN9wUlIJ7WFVcU~kVxAAwA9baIFydp9jSUpZIsaeQyjC4p5V8jRNp-BwIfm2YGqmN1kDT38v1Nruzb22olniTGo08RHULJbuP647H0uBo617j0GAeh0~uylJZHLn0k5Wt~o~TDMn26zN0kSQaWTn-j~GIqKSgq19DgT3BtVqVZIaXB8RpaEWusqMfzCZBcB7v2lbkr23qI9jKfNX~JY64hJ6eRwxmkr-ztCmDtTlDgiXHPK2K3~rle3A__&Key-Pair-Id=KUT5TJCACFTXG","Assembly and Senate health committee members spent substantial time at the informational hearing on whether to include infertility services — including in‑vitro fertilization (IVF) — in California’s EHB benchmark package.

Why it matters: Infertility services are expensive and, if adopted as part of the EHB, would become required benefits in individual and small group plans. The choice affects access and out‑of‑pocket costs for people who need fertility care and has measurable premium implications across the individual market.

Actuarial viewpoints: Wakely actuary Matt Slaughter explained the firm priced multiple IVF benefit packages, reporting broad ranges driven by benefit design. Slaughter said the three illustrative IVF pathways Wakely priced produced marginal allowed‑cost impacts in a per‑allowed‑cost percentage range (examples shown in Wakely materials) and that the IVF options Wakely provided ranged roughly from 0.61% to 0.87% of total allowed costs depending on richness and storage assumptions. He emphasized Wakely’s numbers were steady‑state allowed costs and do not include pent‑up demand or downstream savings.

CHBRP (California Health Benefits Review Program) provided a silver‑plan per‑member‑per‑month (PMPM) estimate focused on an option aligned with last year’s legislation, SB 729. CHBRP director Darren Corbett said the program produced a $5.36 PMPM estimate for infertility services under the SB 729 package, noting CHBRP built its estimate on assumptions of no baseline coverage and included administrative load and current medical trend projections.

Stakeholder testimony: Multiple patients and advocacy groups urged robust coverage. A series of public commenters described high out‑of‑pocket costs: one couple said they spent more than $50,000 on out‑of‑state treatments; another said they paid about $20,000 for a successful cycle and called the financial and emotional burden “overwhelming.” Medical groups including physicians, SEIU representatives and family‑building coalitions urged adoption of a pathway comparable to SB 729 — which sponsors and clinicians described as permitting multiple retrievals, storage and multiple transfers in keeping with professional guidance.

Equity and definitions: Testimony from LGBTQ+ advocacy groups and others urged a nondiscriminatory infertility definition and inclusion for people seeking assisted reproductive care regardless of sex, gender identity or family structure. Panelists and counsel noted CMS scrutiny of condition‑specific or age‑limited language; CMS expects nondiscriminatory, medically necessary language rather than coverage limited to a particular subgroup.

Unresolved questions: Committee members and actuaries requested more transparent unit‑cost data, a clearer comparison of Wakely and CHBRP assumptions, and issuer‑level premium impact modeling that Covered California said it could not produce within the near‑term timeframe. Lawmakers asked whether donor sperm/egg and surrogate medical care would be included; actuaries and panelists said some definitions and coverage elements vary by option and need explicit drafting.

Ending: Advocates urged the committee to adopt a comprehensive IVF pathway; actuaries and regulators said California can choose a pathway but must remain under the CMS typicality ceiling and provide defensible actuarial justification. No final selection was made at the hearing.","Stakeholders urged inclusion of infertility diagnosis and in‑vitro fertilization in the EHB benchmark. Wakely and CHBRP presented differing price ranges; advocates urged pathway aligned with SB 729. Lawmakers asked for clearer unit costs and covered services.",{"_33":113,"_35":36,"_37":38,"_39":114,"_41":115,"_43":116,"_45":117,"_47":118,"_49":119,"_51":120,"_53":121,"_55":56,"_57":58,"_59":122,"_61":62,"_63":64,"_65":123,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6667401,"California health panels press for fast decisions as state reviews 2027 essential health benefits",2010,2037000,4047000,"/Search/View?dp=1&key=2264085-db56d023f6014199baa73eb8c84d4f3d&start=2037&end=4047","https://assets.pipeline.soar.com/2264085-db56d023f6014199baa73eb8c84d4f3d/thumbnail_2037000.jpg","/articles/6667401/California/California-health-panels-press-for-fast-decisions-as-state-reviews-2027-essential-health-benefits","https://secure.pipeline.soar.com/6667401-49252fa680dafadaf825ed88c659cdde/orig.mp4?Expires=1771160264&Signature=kBfPAj1oa~bjPN7WIYh6YTAyuOzYGabTOowDkUnjNQKdA9RTmzKnt1uUVRLjox1q3EQBKcC99pdJ5Ng2N8tC7WK7cDKj8VnZw1Di7GLhXqZNJzYKAyZRiT91STA3OhZbKrtmWEQwbSdF3pwHinTbuQsmBHQ5jSqtTDuqxdFFSefbPHNFvKE~dBI4WPNtR2iPl6NDk6qybJDW~HIPxW-0UtuaMeDZkGUyfkpxwm9D7wDqVoUb8Jrv7fdfdDrfD-IIfpnfWblbCBUAlLxczVAZ60jhXmcxOoO5v6Lbo17Jk-rcZTCkKHWSEIbAfC~XSAmfzag9uX0BfhsCIXpCRC6IJw__&Key-Pair-Id=KUT5TJCACFTXG","Assemblymember Mia Bonta, chairing a joint informational hearing of the Assembly and Senate health committees, opened the session by saying the hearing would consider options for California’s essential health benefits (EHBs) benchmark and the actuarial work behind any changes. \"The Affordable Care Act requires health plans sold in the individual and small group markets to offer a comprehensive package of items and services known as essential health benefits or EHBs,\" she said, noting the state must submit any new benchmark package to the federal government by May in order for changes to take effect Jan. 1, 2027.

Why it matters: changing California’s benchmark determines which services individual and small-group plans must cover across the state. The committee’s work will constrain or expand coverage — and can affect premiums for millions of consumers and the state’s exchange, Covered California.

Mary Watanabe, director of the Department of Managed Health Care (DMHC), outlined the procedural steps already taken and the schedule ahead. She told members the DMHC began stakeholder meetings in June and shared preliminary actuarial work in January. Watanabe said the department seeks committee input so it can finalize a package for public notice and the required actuarial report, with a short comment window before a May submission to the Centers for Medicare & Medicaid Services (CMS). \"We do need to make a decision on the final set of benefits that will be part of the submission,\" Watanabe said.

Wakely Consulting Group actuary Matt Slaughter summarized the federal regulatory constraints that shape any application. Newer 2019 and 2024 federal guidance allows states more flexibility to assemble an a‑la‑carte benchmark, but Slaughter emphasized a central test: the CMS “typicality” or benefit‑richness ceiling. That ceiling is derived by comparing ten federal benchmark options and choosing the most generous plan as a cap; states may not adopt a package richer than that comparison. Slaughter said Wakely’s pricing work shows the benefits under consideration would increase allowed costs by between roughly 1.6% and 3.5% under several definitions; the typicality test ceiling in the firm’s comparison produced a maximum room to add benefits of about 1.06% to 2.23% of allowed costs, meaning the state cannot add everything on the menu at once.

The hearing also clarified scheduling tradeoffs. Legal and agency counsel explained that a state submission in May 2025 would become effective Jan. 1, 2027; if California waits and submits in May 2026, new benefits would take effect in 2028. Wakely and DMHC staff warned that work beyond this year would require updating analyses and possibly re‑pricing benefits if major market or federal changes occur.

What was not decided: the committee did not vote on any benchmark package. Committee members asked for tighter cost definitions, more detail on benefit definitions, and confirmation of how CMS treats condition‑specific language; staff and consultants said more work would be needed before a final decision and stressed the short windows for public comment if the state seeks a 2027 effective date.

Looking ahead: committee leaders said they planned to use the public comment record, the actuarial analyses and additional rates impact modeling to reach a near‑term decision about which subset of benefits to include in the May filing. DMHC will post a draft package for a three‑week comment period, with an anticipated second comment window in April if changes are made.

Ending: The hearing framed the EHB exercise as a constrained menu of choices rather than an open budget: federal rules and the typicality test limit how much California can add, and the state must weigh coverage gains against premium impacts and the practical deadlines tied to CMS review.","Legislators and regulators heard actuarial and legal overviews of the Affordable Care Act process to set California’s essential health benefits benchmark, the May submission deadline for a 2027 effective date, and a federal “typicality” cap that limits how much benefit richness the state can add.","actionData","errors"]

Article not found

Covered California and CHBRP warn EHB expansion could raise premiums as federal subsidies remain uncertain

Durable medical equipment, cranial prostheses and chiropractic services among benefits priced in EHB review

Parents and advocates press state to add hearing aids to EHBs after committee hears access gaps

Lawmakers and patients press to add infertility and IVF to California’s essential health benefits

California health panels press for fast decisions as state reviews 2027 essential health benefits