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State insurance regulators are negotiating with the Centers for Medicare and Medicaid Services now to determine what benefits at fully insured small-group employer health plans might look like in 2027 and later years.
One of the fights is over which state benefits mandates might disappear, and when.
CMS officials say states should either eliminate any state benefits mandates added since 2011 or defray the cost to the federal government of providing any premium subsidies and other federal subsidies that consumers and employers use to pay for those state-imposed mandates.
State officials are asking CMS to apply the requirement that states pay for any extra benefits mandates only for mandates imposed in 2027 or later.
"This approach would avoid changing the rules after states have already acted and provide clear notice of the choices confronting states when they consider new mandates," the top officers of the National Association of Insurance Commissioners, a group for state insurance regulators, write in a letter commenting on the CMS benefits mandate proposal.
What it means: Negotiations over state benefits mandate rules could affect how fully insured small-group plans cover the kinds of services commonly required by state benefits mandates, such as coverage for hearing aids and services for children with autism.
The history: Officials in the administration of former President Joe Biden tended to be warm or neutral toward benefits mandates. Officials in the administration of President Donald Trump see state mandates as a major source of health coverage cost increases.
Some states have tried to add dental benefits, hearing aid benefits and autism services benefits to coverage requirements.
California Gov. Gavin Newsom — the Democratic leader of what is commonly viewed as a pro-mandate state — cited concerns about the high cost of health coverage in the fall when he vetoed bills that could have added mandates for HIV prevention product coverage, menopause management services and behavioral health services for wildfire survivors to the California coverage requirements.
Trump administration officials included provisions meant to prune state benefits mandates in a set of draft 2027 health benefits parameters that was released in February.
The scope of the proposed CMS change: The changes that CMS proposed for state benefits mandate provisions would apply to non-grandfathered, fully insured small-group plans that are subject Affordable Care Act major medical insurance requirements, as well as to non-grandfathered individual major medical coverage.
The draft parameters would not apply to products that fall outside the scope of the ACA major medical insurance requirements, such as short-term health insurance.
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