EHB-Benchmark Plan Modernization Grant for States with a Federally-Facilitated Exchange | CMS 2U2 25 001

Opportunity Information: Apply for CMS 2U2 25 001

The EHB-Benchmark Plan Modernization Grant for States with a Federally-Facilitated Exchange is a CMS discretionary grant designed to help certain states update and strengthen their Essential Health Benefits (EHB) benchmark plans. CMS is aiming this funding at states that rely on the Federally-facilitated Exchange (FFE) because many of these states have not recently revisited their EHB-benchmark plans, even though medical evidence, clinical guidelines, and standards of care have changed over time. The concern CMS highlights is that when benchmark plans are not modernized, the benefits covered in Qualified Health Plans (QHPs) sold through the Exchange may lag behind current clinical practice, and enrollees may also face practical barriers to accessing covered services, such as high costs, claims denials, utilization management requirements, or benefit designs that can function in discriminatory ways.

The grant is meant to reduce the real-world hurdles states face when they consider improving EHB coverage. CMS notes that updating EHB is not a small task: it often requires a comprehensive review of the existing EHB-benchmark plan, structured public input on gaps or access issues in the state, and then the preparation and submission of an official application to CMS to revise the state benchmark under the federal process at 45 CFR 156.111. In other words, the funding is not just about policy ideas; it is intended to support the practical work of analysis, stakeholder engagement, and the formal steps required to make a benchmark change happen.

Eligibility is limited to a state governments executive branch agency that regulates the non-grandfathered individual and small group health insurance markets in the state. CMS makes a point of saying that a state can still be eligible even if it lacks statutory authority to enforce EHB requirements, is not currently enforcing EHB requirements, or CMS has determined the state is not substantially enforcing EHB requirements. The key exchange-related requirement is that the state must have an FFE as of January 1, 2026. CMS lists the states expected to have an FFE on that date as: AL, AK, AZ, DE, FL, HI, IN, IA, KS, LA, MI, MS, MO, MT, NE, NH, NC, ND, OH, OK, SC, SD, TN, TX, UT, WV, WI, and WY.

From an administrative standpoint, this is a grant (funding instrument type: Grant) under the Affordable Care Act activity category, with CFDA number 93.679, offered by the Centers for Medicare and Medicaid Services. The funding opportunity number is CMS 2U2 25 001. CMS anticipates making up to 28 awards, with an award ceiling of $375,000 per award. The opportunity was created on November 13, 2024, and the original application closing date is January 15, 2025. The overall purpose is straightforward: give FFE states resources to do the intensive, often underfunded work of reviewing and modernizing EHB-benchmark plans so that Exchange plan coverage and access to essential benefits better reflect current science, medicine, and patient needs.

• The Centers for Medicare Medicaid Services in the affordable care act sector is offering a public funding opportunity titled "EHB-Benchmark Plan Modernization Grant for States with a Federally-Facilitated Exchange" and is now available to receive applicants.
• Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.679.
• This funding opportunity was created on 2024-11-13.
• Applicants must submit their applications by 2025-01-15. (Agency may still review applications by suitable applicants for the remaining/unused allocated funding in 2026.)
• Each selected applicant is eligible to receive up to $375,000.00 in funding.
• The number of recipients for this funding is limited to 28 candidate(s).
• Eligible applicants include: State governments.

Apply for CMS 2U2 25 001

[Watch] Creating a grant proposal using the step-by-step wizard inside the applicant portal: