The ACA’s EHB has resulted in a state-by-state patchwork of coverage for children and adolescents and has significant exclusions.

The analysis suggests four potential policy steps-
1. Pediatric treatment limits and exclusions, particularly exclusions based on mental retardation, mental disability, or other developmental conditions should be barred.
2. The concept of ‘medical necessity’ should be incorporated into the pediatric benefit. Medical necessity should include the clinical utility and appropriateness of a covered service and also determine whether the service is appropriate in the pediatric developmental health context.
3. The essential health benefits standard for pediatric services should be revised to address both covered services, particularly for children with special needs, and actuarial value.
4. The use of CHIP plans as a benchmark plan for pediatric services should be permitted.
The analysis was conducted by researchers from PolicyLab at The Children's Hospital of Philadelphia; Children's National Health System in Washington, DC; Johns Hopkins Bayview Medical Center; and the Milken Institute School of Public Health at the George Washington University (GW); and is published in the December issue of Health Affairs.
Source-Medindia