The ACA’s Pediatric Essential Health Benefit Has Resulted In A State-By-State Patchwork Of Coverage With Exclusions

In Health Affairs, Kathleen Noonan, co-director of the CHOP PolicyLab, and colleagues investigate how the Affordable Care Act’s (ACA) pediatric essential health benefit has been implemented by states. They look at how state benchmark plans - the base plan chosen in each state as the standard or benchmark of coverage in that state under ACA rules - address pediatric coverage in plans governed by the essential health benefits standard. The review of summaries of all the state benchmark plans found that no state specified a distinct pediatric services benefit class. Furthermore, although benchmark plans explicitly included multiple pediatric conditions, many plans also specifically excluded services for children with special health care needs. This benchmarking approach resulted in a state-by-state patchwork of coverage for children and adolescents. Noonan has written a blog about the paper and it has also been included in the New York Times’ Upshot column.