By Joe Touschner

We’ve posted in the past about the essential health benefits–the package of benefits that will be the basis for all health plans in the individual and small group markets and for some in Medicaid starting in 2014. Last month, the Institute of Medicine made recommendations to the Department of Health and Human Services on how to choose the essential health benefits, but HHS wants to hear other perspectives, too. The Department is holding ten “listening sessions” across the country to allow anyone to provide input on EHBs. The first session will be this Friday, November 4 in Chicago and the last on November 21 in San Francisco. See the full list here.

What message should advocates for kids and families carry to these meetings? The 100% Campaign in California has provided a strong example in a letter they’ve already provided to HHS, which was also signed by two dozen other organizations in the state. Their key points (with my additions in parentheses):

• Children have unique health needs (and are often not well served by the typical small employer health plan, the model the IOM identified for the essential health benefits).

• Instead, Medicaid’s EPSDT benefit standard should be the model for kids’ benefits in the EHB.

• The definition of “medical necessity” is important to assuring kids get all the services they need (especially for kids’ developmental and habilitative needs) and again in this area EPSDT provides a stronger model than private plans.

• The essential health benefits represent an opportunity to address health disparities by providing benefits that not only treat disease, but promote and maintain health for those who will be newly eligible for exchange subsidies and Medicaid.

Child advocates will want to emphasize that kids should have access to the services that are medically necessary and that affordability from a family’s perspective needs to take into account not just premium costs, but cost-sharing and any costs for services that are necessary but not covered. Those planning to attend may also want to address the questions that HHS has posed for attendees:

• In keeping with the title of the Institute of Medicine report “Essential Health Benefits–Balancing Coverage and Cost”, how can the Department best meet the dual goals of balancing the comprehensiveness of coverage included in essential health benefits and affordability?

• How might the Department ensure that essential health benefits reflect an appropriate balance among the categories so that they are not unduly weighted toward any category?

• What policy principles and criteria should be taken into account to prevent discrimination against individuals because of their age, disability status, or expected length of life as the Affordable Care Act requires?

• What models should HHS consider in developing essential health benefits?

• What criteria should be used to update essential health benefits over time and what should the process be for their modification?

Once the listening sessions are complete, HHS will write a proposed rule that provides more definition of the essential health benefits. We’ll all have a chance to weigh in then in writing before the rule becomes final, but this month is your chance to speak in person to HHS officials on the importance of providing strong benefits for kids. Other stakeholders will surely be making their case, so kids and families need strong representation, too.