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Gov. Gavin Newsom submitted an application to federal authorities to update the state's benchmark plan. Pending approval, the plan would expand required health coverage to include fertility treatments, hearing aids, and mobility devices starting in 2027.
The Department of Managed Health Care applied with the Centers for Medicare & Medicaid Services to revise coverage requirements for essential health benefits in individual and small-group markets. The proposed changes would cover in vitro fertilization and other fertility services, annual hearing examinations and hearing aids, and mobility equipment.
"Quality health care should be available for all Californians, and one way we are working to achieve this goal is by updating the state's benchmark plan for required health benefits," Newsom said. "My administration has been working over the last year, in collaboration with the state Legislature, to expand coverage for important and needed health care services, including fertility services, hearing aids and wheelchairs. These new coverage requirements will have life-changing impacts for millions of Californians."
The benchmark plan establishes minimum coverage standards for state health insurance plans. Under the federal Patient Protection and Affordable Care Act, health plans in individual and small group markets must offer essential health benefits across 10 broad categories. This includes primary care, hospital services, prescription drugs, and emergency services. States have the flexibility to determine specific services within these categories through their benchmark plans.
Senator Caroline Menjivar, chair of the Senate Health Committee, called the move "a huge step forward for people with hearing loss, disabilities, and those struggling with infertility." She highlighted the potential impact on children with hearing loss, noting coverage for hearing aids "make a significant difference in their development and well-being."
Assemblymember Mia Bonta, who chairs the Assembly Health Committee, emphasized the initiative demonstrates "our statewide commitment to prioritizing meaningful access to care." She pointed to the everyday benefits for families seeking fertility treatment, children with hearing impairments, and individuals with mobility limitations.
"The updates will close coverage gaps for millions while enhancing access to fertility services, hearing aids, and wheelchairs, easing the burden on families seeking these vital health care services," California Health & Human Services Agency Secretary Kim Johnson said.
The application follows a year-long process of consultation and planning. The DMHC held public meetings to gather input on potential expanded benefits and issued public notices about the state's intentions. These forums allowed stakeholders to comment on which benefits should be included in the revised benchmark plan.
If federal authorities approve, the expanded coverage requirements will take effect on Jan. 1, 2027. The changes would affect health plans in the individual and small group markets, setting a new standard for commercial health coverage in the state.
The initiative is California's effort to address specific healthcare needs that may require significant out-of-pocket expenses for many residents. By including fertility treatments in essential coverage, the state would join a limited number of states that mandate insurance coverage for procedures like IVF, which can cost tens of thousands of dollars.
The federal review process will determine whether California's proposed benchmark plan meets the ACA's requirements, including ensuring the new plan provides benefits substantially equal to those of the typical employer plan in the state.
