The Essential Health Benefits (EHB) Workgroup was established by Governor Kitzhaber for the purpose of recommending an essential health benefits package benchmark plan for Oregon’s individual and small group market.  The United States Department of Health and Human Services (HHS) proposed that essential health benefits be defined using a benchmark approach reflecting a “typical employer plan.”  

After several discussions and the consideration of public comment received throughout the process, the EHB Workgroup recommended one of ten beachmark plans specified by HHS and ensured the inclusion of the ten statutory-required categories of services and needed supplements for missing benefit categories. 

Roster
Charter  

  
Medicaid Essential Health Benefits

Recommendations and discussion information was also forwarded to the Medicaid Advisory Committee (MAC) for consideration in their process of determining EHBs for Medicaid.  The MAC began discussing EHBs in July and will continue to assess benchmark options with a goal of final determination being made by the end of 2012.  Click here for information on the MAC and their EHB process.

To review the final submission of Oregon's proposed state Essential Health Benefits Benchmark Plan and other state plans, please visit The Centers for Medicare & Medicaid Services website at http://cciio.cms.gov/resources/data/ehb.html#oregon.

Related Rulemaking
Oregon's Senate Bill 91 (2011) gives the Department of Consumer and Business Services authority to adopt rules ensuring that health plans sold in Oregon's individual and small group markets comply with these requirements. Click here for more information about the proposed rulemaking.  
 
Informational Documents
HHS Essential Health Benefits Bulletin, Dec. 2011
HHS FAQs on Essential Health Benefits Bulletin, Feb. 2012
"Health Policy Brief: Essential Health Benefits," Health Affairs/RWJ Foundation, April 2012
"Essential Health Benefits: Balancing Coverage and Cost," Institute of Medicine, Oct. 2011
Oregon Mandated Benefits, Oct. 2011
 
Staff:  Melissa Isavoran, 503-373-7959, Melissa.Isavoran@state.or.us
           Anthony Behrens, 503-947-7129, Anthony.A.Behrens@state.or.us