HHS Releases FAQ on Essential Health Benefits

March 2012

On February 17, 2012 the Department of Health and Human Services (HHS) issued a list of frequently asked questions (FAQs) to provide additional information on HHS’s intended approach to defining essential health benefits (EHB). The EHB definition will ensure that health insurance plans in the individual and small group markets, both inside and outside of the Affordable Insurance Exchanges, as well Medicaid alternative benefit plans defined under Section 1937 of the Social Security Act, offer a comprehensive package of service and items.

These FAQs follow a December 16, 2011 bulletin released by HHS, which outlined proposed policies related to EHB that HHS plans to define in future rulemaking. HHS is publishing the FAQs in order to be responsive to States and to give stakeholders timely information as they work towards establishing Affordable Insurance Exchanges and making decisions for 2014.

Questions 20-22 in the FAQs relate specifically to Medicaid. CMCS will be releasing future guidance on Medicaid benchmarks and essential health benefits.

The Frequently Asked Questions are available at:


To view the essential health benefits bulletin released by HHS on December 16, 2011, visit:


Questions about essential health benefits (for Medicaid and more generally) can be sent to:


For More Information:

If you have any comments or questions regarding any of the above information, please do not hesitate to call (708)717-9638 or e-mail larry@larrygrudzien.com

Thank you,

Larry Grudzien
Attorney at Law