Nebraska Medicaid Changes

Initiative 427

The Nebraska Medicaid program currently provides coverage to approximately 240,000 Nebraskans, with expenditures totaling $2,117,730.000 in 2018. Nebraska voters passed Initiative 427 in the November 2018 election that expanded Medicaid coverage to eligible able-bodied adults ages 19-64 who earn up to 138 percent of the federal poverty level. That is about $17,000 per year for a single adult. Governor Pete Ricketts’s administration is tasked with implementing the voter’s approved Medicaid expansion. The Nebraska Department of Health and Humana Services director, Matthew Van Patton, contacted CMS (Center for Medicare & Medicaid Services) to receive support for the state Medicaid program that enlarges Medicaid in Nebraska. This was part of provisions in the Patient Protection and Affordable Care Act (ACA), a.k.a. Obamacare. The name of the Nebraska Medicaid change is the Heritage Health Adult (HHA) expansion program.

Heritage Health Adult

The Heritage Health Adult is designed to improve population health. Many of the individuals in the 19-64 population had not obtained health coverage in the past. That age group of excluded from Medicaid. Their income was too high, or employers did not offer group health coverage. This has hurt those individuals as well as our community as a whole. We see that with the high numbers of lower-income and minorities contracting COVID. One of the program’s goals is to improve the health of the overall Nebraska community by providing health coverage to the uninsured.

Basic & Prime Medicaid

The program is a tiered system divided into two benefit tiers–Basic and Prime. The essential Medicaid services are like it sounds. It will consist of a robust package of services available to those low-income individuals who qualify. The Prime tier is designed for those who more actively engage in the program through wellness and personal responsibility engagement activities. Those who engage will qualify for prime coverage, such as dental, vision, and over-the-counter drugs. Providing health care in this manner is designed to help reduce per-capita costs.

Medically Frail

Many people eligible for expansion will have particular health needs that may be barriers to improving health. These people can be designated “Medically Frail” and will receive Prime benefits. Visit the Medically Frail web page for more information about the process.

 Nebraska Medicaid Changes Show Up in Managed Care Plan

Nebraska’s Medicaid managed care program, Heritage Health, combines Nebraska Medicaid’s physical health, behavioral health, and pharmacy programs into a single comprehensive and coordinated program for the state’s Medicaid and Children’s Health Insurance Program (CHIP) enrollees. Heritage Health members enroll in one of three statewide health plans to receive their health care benefits. Nebraska Total Care. WellCare. United Healthcare Community Plan. The private companies manage the care of the Medicaid beneficiaries on behalf of the state of Nebraska’s Medicaid system. These are managed care plan forms.

Many times clients who are on Medicare will call about Medicaid. We have many clients who are on both Medicare and Medicaid. Some of those clients qualify for the special needs plans that coordinate the two and give some very generous additional benefits. However, the Nebraska Medicaid changes that Initiative 427 caused do not affect people on Medicare and Medicaid. The program expansion is just for those between the ages of 19-64 and not on Medicare. We still get phone calls, however, asking whether they qualify. If you wish to check and see if you may qualify for Medicaid or other programs that the Nebraska Department of Health and Human Services provides, please call 402-595-2850.