Children's Health Insurance Expansions: State Experiences in Developing Benefit Packages and Cost-Sharing Arrangements. Non-Medicaid Options for Benefit Packages Under Title XXI


For states not choosing to expand coverage through Medicaid, Title XXI provides four options for designing a benefit package: (1) coverage of benefits equivalent to those provided in a benchmark benefit package; (2) coverage of benefits actuarially equivalent to one of the benchmark benefit packages; (3) coverage of comprehensive benefits provided by an existing children's health program; and (4) other health plans that the Secretary deems appropriate for serving low-income children. There are three benchmark benefit packages on which states can model their programs: the standard Blue Cross/Blue Shield Preferred Provider option offered under the Federal Employees Health Benefits Program (FEHBP); a health benefits plan that is offered and is generally available to State employees; or the HMO with the largest non-Medicaid commercial enrollment in the state. If the state chooses not to utilize one of those benefit packages, the state can design a benefit that is actuarially equivalent to one of these plans.

Because states have the option to implement a separate program based on these four options, there will be variations in benefit packages across states. Consequently, the issues states face in assuring quality of services and in making decisions about optional benefits such as dental and vision care will vary based on the type of program option selected.