May 13, 2025
California Updates from the Department of Managed Health Care (DMHC)
Updates to California’s Benchmark Plan, Essential Health Benefits
The DMHC submitted an application to CMS, on behalf of the state, to update California’s benchmark plan. The new benchmark plan would expand coverage requirements for essential health benefits (EHBs) in the individual and small group markets starting in 2027, following CMS approval.
WHAT THIS MEANS: Expanding covered benefits through the new benchmark plan followed an extensive public process over the last year. Adopting a new benchmark plan would expand coverage to include services to evaluate, diagnose, and treat infertility including in vitro fertilization (IVF) and artificial insemination, an annual hearing exam and hearing aids, and expanded durable medical equipment (DME) benefits, including coverage for mobility devices such as walkers, manual and power wheelchairs, and scooters, among other new DME coverage.
The DMHC worked with the Administration, state Legislature and many stakeholders to update California’s benchmark plan, including holding public meetings to share information on expanding the EHBs and the process to update the state’s benchmark plan.
Visit the Department’s website for more information about the benchmark plan.
Health Plans Must Assist Members Impacted by Natural Disasters
The DHMC is reminding Californians that health plans must ensure health plan members impacted by natural disasters, including floods, earthquakes, and wildfires, continue to have appropriate access to medically necessary health care services.
This may include:
- speeding up approvals for care;
- replacing lost prescriptions and ID cards; or
- quickly arranging health care at other facilities if a hospital or doctor’s office is not available due to the disaster.
Read the DMHC’s consumer-focused fact sheet (available in English and Spanish) for more information about what health plans are required to do to help health plan members impacted by a natural disaster.
Resources for Health Plan Members Impacted by Wildfires in Southern California
The DMHC published a resource guide to help health plan members impacted by the wildfires in Southern California find information on how their health plan can help them. The guide also provides contact information for health plans operating in Los Angeles and Ventura counties.
For more information and resources from state, local and federal government visit CA.gov/LAfires.
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