This issue brief is part of a two-brief series that provides background on EHBs in California and how they could change in future years. This issue brief explains what defrayal is and what triggers defrayal; how defrayal costs are determined; how mandates may be introduced without triggering defrayal; and also provides an example of two states that introduced the same mandate that exceeded EHBs in different ways.
Issue Brief
Essential Health Benefits: Exceeding EHBs and the Defrayal Requirement
This issue brief is part of a two-brief series that provides background on EHBs in California and how they may change in future years. This brief provides an overview of how EHBs are defined at the federal level and in California, including how HHS regulations allow a state to alter its selection of its benchmark plan and thus make some alterations to its definition of EHBs.
Issue Brief
Essential Health Benefits: An Overview of Benefits, Benchmark Plan Options, and EHBs in California
This explainer provides an overview of the population aged 65 and older in California, including sources of health insurance, demographic information, and how legislation and regulations may impact insurance coverage for this population
This article discusses key issues in relation to adverse childhood experiences (ACEs) and potential changes in screening utilization and associated expenditures resulting from the recent ACEs legislation in California.
External Publication
Policy Considerations for Routine Screening for Adverse Childhood Events (ACEs)
This issue brief discusses the medical necessity determination process, which may involve multiple clinicians, for enrollees in health plans and health policies regulated by the Department of Managed Health Care (DMHC) or the California Department of Insurance (CDI).
Issue Brief
Medical Necessity Determination Process for Covered Benefits
