EHB-Benchmark Plan Modernization Grant for States with a Federally-Facilitated Exchange

The EHB-Benchmark Plan Modernization Grant for States with a Federally Facilitated Exchange is offered by the Centers for Medicare and Medicaid Services (CMS) through the Center for Consumer Information and Insurance Oversight. With a funding pool of $10.5 million, this grant aims to support state governments in reviewing and modernizing their Essential Health Benefits (EHB) benchmark plans to reflect advances in clinical care, address healthcare accessibility challenges, and support health equity. States eligible for this grant include those with a Federally Facilitated Exchange (FFE) expected as of January 1, 2026, which covers 28 states. States operating a State-Based Exchange (SBE) are not eligible. Applications are due by January 15, 2025, with an optional letter of intent requested by December 16, 2024. Grants are anticipated to start by March 14, 2025. The program’s primary objective is to assist states in conducting comprehensive reviews of their EHB-benchmark plans, with particular focus on identifying gaps in access, cost challenges, and potential updates to reflect medical advancements. Grantees must address how EHB plans can better serve populations at risk of healthcare disparities, including those with lower incomes, children, older adults, individuals with disabilities, rural residents, and historically underserved communities. In addition, each state is encouraged to explore updates related to national and state-specific health concerns such as mental health, opioid use, and conditions like diabetes and obesity. States are expected to submit findings in a Section 508-compliant report that will be publicly available, with an option to apply for further updates to their EHB-benchmark plans during the grant period. Each eligible state will receive a base award of $250,000, with an additional $125,000 available for states that choose to establish an advisory board to guide the review process. Advisory boards should include representatives from diverse populations, such as those from underserved or marginalized communities, to ensure inclusive input into EHB benchmarking. Grant funds cover a three-year period, allowing states ample time to engage in comprehensive analyses, public consultations, and planning for any necessary EHB updates in compliance with 45 CFR 156.111. Applicants must submit a comprehensive project proposal, including an abstract, a 15-page project narrative detailing goals, proposed activities, and a timeline, along with a budget narrative. Attachments should include resumes for key personnel, an organizational chart, and eligibility documentation affirming the state’s qualifications and commitment to not using other federal funds for similar activities. Applications will be evaluated based on feasibility, organizational capability, alignment with program goals, and cost-effectiveness. States that include a clear health equity plan within their project goals may receive additional scoring consideration. CMS will manage the review process, including initial and merit reviews, with evaluation criteria emphasizing the project narrative, work plan, and budget narrative. Successful applicants must adhere to reporting requirements including semiannual progress reports and Federal Financial Reports. CMS also emphasizes compliance with cybersecurity, data protection, and non-discrimination policies as part of the post-award conditions.