The California State Capitol in Sacramento. Photo: Jason Doiy/ALM
California may add hearing care benefits and wheelchair benefits to the standard essential health benefits (EHB) package that shapes the state's individual health coverage and fully insured small-group health coverage.
The state's Department of Managed Health Care submitted a draft of its EHB package update to the Centers for Medicare and Medicaid Services Monday.
Recommended For You
The hearing care benefits, for example, would include coverage for routine hearing screenings, hearing exams to determine the need for hearing correction, and one hearing aid per ear every three years.
A durable medical equipment benefit would provide coverage for portable oxygen devices, hospital beds, blood glucose monitors, and a wide range of mobility devices, including walkers, scooters, and manual and power wheelchairs.
A new in vitro fertilization benefit would make coverage for up to three attempts to create embryos through an IVF process a standard benefit.
If approved, the EHB update would apply to coverage that takes effect on or after Jan. 1, 2027.
What it means: California is the most populous U.S. state, with 39 million residents, and it has Democrats in charge of its governorship, state Senate and state Assembly.
How CMS handles California's EHB package proposal could show how the commercial health insurance market rules in states led by Democrats will work now that Donald Trump is back in the White House.
Trump has criticized the current Affordable Care Act framework for health coverage, but, at press time, he had not announced efforts to repeal the ACA or to eliminate ACA rules that have been popular with consumers, such as the ACA ban on health insurers considering applicants' health status when selling and pricing health coverage.
Related: California may stop AI bots from calling themselves doctors
California has been more cautious about adopting progressive health insurance proposals than states like Hawaii, Massachusetts, Oregon and Vermont have been.
Last year, for example, Gov. Gavin Newsom, a Democrat, vetoed bills that could have established a new pharmacy benefit manager regulation system and created new review standards for health care deals involving private equity investors.
Essential health benefits: The federal Affordable Care Act requires all states to develop an EHB package.
The EHB package is supposed to reflect the kind of coverage that an ordinary employer plan in a state might offer.
Each individual health insurance policy and small-group health insurance plan in a state is supposed to provide coverage that's "substantially equal" to the plan described in the state's EHB package benefits list.
Regulators use the EHB package to divide plans into "metal tiers," or benefits richness levels, with the richest plans, or platinum plans, covering about 90% of the actuarial value of the EHB package, and the leanest standard plans, bronze plans, covering about 60% of the actuarial value of the EHB package.
© 2025 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.
Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
