EHB-Benchmark Plan Modernization Grant for States with a Federally-Facilitated Exchange
Closed Posted
- Opportunity number
- CMS-2U2-25-001
- Agency
-
Centers for Medicare and Medicaid Services
Department of Health and Human Services
- Applications due
- Award size
- Up to $375,000
Opportunity facts
- Assistance listings
- Funding instrument
- Grant
- Category
-
- Affordable Care Act
- Eligible applicants
-
- State Governments
Opportunity details come from Grants.gov. Updated .
About this opportunity
The EHB-Benchmark Plan Modernization Grant for States with a Federally-Facilitated Exchange (FFE EHB Mod Grant) is a new grant program offered by the Department of Health and Human Services Centers for Medicare and Medicaid Services. This grant funding will support states with Federally-Facilitated Exchanges (FFEs) in reviewing and updating their Essential Health Benefit (EHB) benchmark plans. The goal is to help states modernize their EHB benchmark plans to reflect changes in medical evidence, scientific advancement, and healthcare needs. Eligible applicants are state executive branch agencies that regulate the non-grandfathered individual and small group health insurance markets. The application deadline is January 15, 2025, with an expected award date of March 14, 2025.
The FFE EHB Mod Grant provides up to $10.5 million in total funding, with a base award of $250,000 per state and an additional $125,000 if the state establishes an advisory board. There are no specific quantities of goods or services procured, as this is a grant program to support state-level activities related to EHB benchmark plan updates.
Synopsis
We know it can be challenging for states to fund the work necessary to improve the Essential Health Benefits (EHB). Improving EHB typically involves:
Comprehensively reviewing EHB-benchmark plans.
- Seeking public feedback on the coverage of EHB in the state.
- Submitting an application to CMS to change the EHB in the state.
- We understand that, due in part to these challenges, that there are many states that have not considered updating their EHB-benchmark plans. These states include 24 of the 28 states expected to have a Federally-facilitated Exchange (FFE) as of January 1, 2026.
As a result, the covered benefits in the Qualified Health Plans (QHPs) offered through the Exchanges in these states may not reflect recent changes in medical evidence, scientific advancement, and clinical care guidelines. Additionally, people enrolled in these QHPs may have trouble accessing EHB because of cost, claims denials, utilization management, discriminatory benefit design, or other factors.
We want to lessen these challenges through the EHB-Benchmark Plan Modernization Grant for States with a Federally-facilitated Exchange (FFE EHB Mod Grant). This new grant program will fund states with an FFE for a variety of activities related to the review of EHB-benchmark plans. The goal is to help applicants modernize and change their EHB-benchmark plans under 45 CFR 156.111.
Files
| File | Type | Posted |
|---|---|---|
| CMS-2U2-25-001_REV1_Final.pdf |
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