Virus forces changes to Nebraska’s Medicaid expansion plan

LINCOLN, Neb. (AP) — Nebraska is changing its plans to expand Medicaid in a way that will force more recipients to start out with a “basic” plan that doesn’t include coverage for dental and vision services or over-the-counter medications, state officials announced Friday.

The Nebraska Department of Health and Human Services said the tweaks were necessary because the federal government is occupied right now with its response to the coronavirus pandemic and doesn’t have time to approve the state’s Medicaid expansion proposal.

Prime coverage that includes all services won’t be available until the federal government approves Nebraska’s proposed waiver for the program, and that decision will likely get pushed off for another six months.

However, department officials said they still plan to start accepting applications on Aug. 1, as scheduled. Coverage will begin as scheduled on Oct. 1.

“We are going to be going forward with Medicaid expansion ... but it will only be the basic package and not the prime package,” Gov. Pete Ricketts said during his daily coronavirus news conference.

Nebraska voters approved a Medicaid expansion measure in 2018 after years of failed attempts to do so through the Republican-dominated state Legislature. The state’s Republican governors have remained adamantly opposed to expansion, although Ricketts promised to respect the will of voters after they passed it.

Critics have accused the governor’s administration of slow-walking the expansion and imposing burdensome requirements on recipients, a charge his administration denies. Shortly after it was approved, state officials announced a two-tier system of coverage, with a “basic” plan for all newly qualified recipients and a “premium” plan for people who are working, in school, volunteering or caring for a relative.

“Our approach better achieves the purpose of the Medicaid program by incentivizing positive activities that will improve health outcomes and encourage life successes for participants,” the department said in a news release.

The basic plan includes coverage for hospitalizations, emergency care, prescription drugs, lab tests, maternity care and other services. The premium plan offers those benefits as well but adds coverage for dental and vision services, and over-the-counter drugs.

To qualify for prime coverage in the first year, recipients would have needed to participate in care and case management, select a primary care provider and have an annual checkup.

But because the federal government has delayed its approval of Nebraska’s plan, prime coverage will only be offered to eligible people who are 19 or 20 years old, pregnant or medically frail, the department said.

A leading advocate for expanding Medicaid said the state should simply offer prime coverage to all recipients and stop tinkering with different levels of coverage.

“While we appreciate that coverage will not be further delayed beyond Oct. 1, 2020 ... we maintain they can and should start coverage now,” said Molly McCleery of Nebraska Appleseed, an advocacy group for low-income people.

An estimated 90,000 Nebraska residents will qualify for coverage once Medicaid is expanded, and McCleery said doing so now would help contain the spread of the coronavirus.

For most people, the coronavirus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia.


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