Lawmakers, advocates press to add hearing aids, DME, wigs and adult dental to California’s EHB; actuarial room limited

Lawmakers pressed state officials on whether hearing aids, home and mobility durable medical equipment (DME), cranial prostheses (medical wigs) and adult dental can be added to California’s essential health benefits (EHBs) for the 2027 plan year.

At the Feb. 11 informational hearing, Wakely actuary Matt Slaughter and Department of Managed Health Care Director Mary Watanabe summarized the options and the fiscal constraints facing the committee. Wakely priced a set of benefits and estimated that the combined marginal allowed-cost impact of the priced items ranged from about 1.6% to 3.5% of total allowed costs, while the CMS typicality ceiling gives the state approximately 1.06% to 2.23% of room to add benefit richness. "So we do have, just with the benefits priced here, it's gonna be more rich than the room we have available," Slaughter said, adding the state will have to select a subset of the options Wakely priced.

Hearing aids

Advocates and multiple lawmakers urged including hearing aids.…