Nebraska Medicaid Issues Expansion Update

Lincoln – The Division of Medicaid and Long-Term Care within the Nebraska Department of Health and Human Services (DHHS), continues its work to expand Medicaid to low-income, able-bodied adults of working age (19 to 64 years old).

Applications will begin to be accepted on August 1st.  Benefits will begin on October 1st.  Expansion will happen on time.

DHHS plans to utilize a section 1115 demonstration waiver to allow beneficiaries the opportunity to earn enhanced benefits by participating in wellness, personal responsibility, and community engagement activities.  Our approach better achieves the purpose of the Medicaid program by incentivizing positive beneficiary activity that will improve health outcomes and encourage life successes for participants. This 1115 waiver must be approved by the Centers for Medicare and Medicaid Services (CMS).

Due to the COVID-19 pandemic, CMS has necessarily focused considerable time and attention towards addressing this unprecedented public health emergency. As a result, CMS has notified DHHS that approval of Nebraska’s 1115 expansion demonstration waiver will not be able to be completed in time for Nebraska’s planned expansion effective date of October 1st.

DHHS is moving forward with expansion with the planned tiered benefits to allow the state to meet our current timeline to accept applications on August 1, 2020 and begin benefits on October 1, 2020. Participating Nebraskans will be able to earn additional, Prime benefits after the 1115 waiver is approved and the additional components of the 1115 waiver are implemented. Retroactive benefits will remain available under the same conditions as today.

Most newly eligible Nebraskans will start with the Basic benefits package, which is a comprehensive benefits package that includes the following services:

  • Ambulatory
  • Emergencies
  • Hospitalization
  • Maternity and newborn
  • Mental health and substance use disorder services, including behavioral health
  • Prescription drugs
  • Rehabilitative & habilitative services and devices
  • Laboratory services
  • Preventive, wellness, and chronic disease management
  • Other services such as long-term care, non-emergency medical transportation, and durable medical equipment

Newly eligible Nebraskans who are 19 or 20 years old, pregnant, or medically frail will receive the Prime benefits package, which is the Basic benefits package plus:

  • Dental services
  • Vision services; and
  • Over-the-counter medications

With the future approval of the 1115 demonstration waiver, beneficiaries receiving the Basic benefits package will have the opportunity to earn the enhanced Prime benefit package.

DHHS will implement expansion on time with a benefit structure that allows future implementation of the wellness, personal responsibility, and community engagement incentives that are ultimately in the best interest of beneficiaries and providers.

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