A voter-approved law to expand Medicaid in Nebraska is quietly taking shape as the state prepares to extend health coverage to an estimated 90,000 recipients, but key challenges still must be resolved and officials haven’t set a firm date to start enrolling people.
Nebraska state officials say they face a huge undertaking with a lot of moving parts. Even though they must submit their plan to the federal government by April 1, administrators say that review could take time and require additional changes.
Administrators want to err on the side of doing it properly rather than rushing the process, said Nebraska Medicaid and Long-Term Care Director Matthew Van Patton.
Van Patton declined to give a specific date for when residents could start getting coverage, saying the agency is still working to upgrade its computers, hire additional workers and negotiate new contracts with groups that will provide services to the new Medicaid recipients.
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“We want to ensure that when we do flip the switch, we’re going to have a good product in the marketplace,” he said in an interview.
But advocates for low-income Nebraskans say they’re concerned uninsured people will continue to go without health care while the state tinkers with its plan. Molly McCleery, a staff attorney for Nebraska Appleseed, a leading proponent of the measure, said her group would like to see enrollment start by fall 2019 so people can get covered by Jan. 1, 2020.
“We definitely understand the concerns of wanting to do it right,” McCleery said. “You want a system that’s effective and user-friendly. But when you look at the enrollment timelines of other states, we think further into 2020 is too late.”
The ballot measure approved in November requires the Nebraska Department of Health and Human Services to submit a state Medicaid plan amendment to the federal government to cover newly eligible, low-income Nebraskans.
Once it’s in place, coverage will become available to adults ages 19 to 64 who earn up to 138 percent of the federal poverty level — about $16,753 per year. The federal government is required to pay 93 percent of the program’s overall costs in 2019 and then 90 percent beginning in 2020.
As they shape their plan, Nebraska state officials have been talking with their counterparts in Arkansas, Indiana and Virginia — all states that expanded Medicaid but imposed work requirements on recipients.
Nebraska officials don’t plan to pursue work requirements but are looking to add “wellness and life success” incentives to its Medicaid program, said Thomas “Rocky” Thompson, the deputy director of Medicaid and Long-Term Care. Critics say work requirements often don’t work as advertised because it’s difficult for people with major illnesses to keep a full-time job.
Van Patton said his agency is also working with the private “managed care organizations” that will provide health care services on the state’s behalf. Nebraska already uses their services for current Medicaid users, but state officials now have to amend all of their contracts to cover the newly eligible.
Managed care organizations receive a set amount of money from the state each month to care for Medicaid enrollees — giving them a financial incentive to keep costs low.
Based on the state’s research, Van Patton said he expects many new Medicaid recipients to be older, with health problems that haven’t been addressed because they previously lacked coverage. They’re also more likely to suffer from more than one problem, which could require them to see different specialists, he said.
“We’ve really paid a significant amount of attention to collecting information” to determine how Nebraska’s program should look, Van Patton said.
Some lawmakers also want to keep watch on the state’s progress. A bill set for a legislative hearing Friday would create a special task force of lawmakers, health care providers and others who will be directly affected by the expansion.
The task force would hold at least one public hearing in each of the state’s three congressional districts to get public feedback on the expansion and report its findings to the Legislature by July 1.
“The whole point is to look at ways we can be innovative and ensure that it’s implemented efficiently,” said state Sen. Adam Morfeld, of Lincoln, who sponsored the bill and co-chaired the ballot campaign to expand Medicaid. “Medicaid is a growing part of our budget, and we need to have a focus on it and educate (other members of the Legislature) on the issue.”