MM Curator summary
The Nebraska Medicaid expansion model includes a feature that provides additional benefits for members who meet wellness efforts and work requirements, and advocates filed a lawsuit to remove those requirements.
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LINCOLN — Health advocates filed a lawsuit Thursday targeting Nebraska’s two-tier system of Medicaid benefits for low-income, working-age adults.
The suit takes aim at what state officials called Heritage Health Adult, under which most Medicaid expansion patients get only a basic tier of benefits.
The state’s plan had been to require that those people meet wellness, personal responsibility and community engagement goals to qualify for dental, vision and over-the-counter medication benefits, which are part of traditional Medicaid coverage.
Nebraska Appleseed attorney Sarah Maresh called the system unlawful because it created “barriers and burdens” for enrollees, in violation of the Medicaid expansion law passed by voters in 2018.
“With coverage beginning last October, community members are ecstatic to finally be able to see a doctor without worrying about receiving a high bill they cannot afford,” she said. “However, we’ve also heard of the frustration and confusion caused by the unnecessary complexities of the tiered benefits system.
“This lawsuit seeks to fully implement the will of Nebraska voters and undo the unlawful actions of the (state Department of Health and Human Services),” Maresh said.
An HHS spokeswoman said the department does not comment on pending litigation.