Reed Smith Client Alerts

Colorado’s new benchmark health insurance plan, which obtained federal approval from CMS on October 12, 2021, will require certain Colorado insurers to provide coverage for a wide range of gender-affirming care. The new requirements, effective as of January 1, 2023, are applicable to individual and small group health plans in the Affordable Care Act (ACA) insurance markets. While Colorado is the first state to include requirements, other states may follow with support from the Biden administration.


The ACA requires individual and small group health plans to provide coverage for “essential health benefits,” but permits each state to develop its own “benchmark plan” detailing which specific services are covered. Each state must obtain CMS approval of its proposed benchmark plan – and the minimum covered services contained therein – to ensure ACA compliance. On October 12, 2021, CMS approved Colorado’s proposed Essential Health Benefit Benchmark Plan for 2023, which for the first time included “gender-affirming care” as an essential health benefit. The benchmark plan, which will go into effect on January 1, 2023, largely expands the scope of gender-affirming medical services that individual and small group plans will be required to cover.