Nebraska Medicaid will have multiple changes starting in 2024


MM Curator summary

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[MM Curator Summary]: New MCOs, a new D-SNP, dental, rx and BH integration, and new EVV requirements- all going live in about 15 months.



HASTINGS, Neb. — The public health insurance program Medicaid is visiting communities across the state to share with healthcare providers and members their new changes. Medicaid is also listening to the biggest struggles the insurance users and healthcare providers are facing.

“One of the first things we want to do is try to understand what the root of the issue is,” said the Director of the Department of Health and Human Services (DHHS) Medicaid & Long-Term Care Division Kevin Bagley. ” What is causing access issues for our members? We heard a lot of that tonight.”

Bagley said that currently around 375,000 Nebraskans are insured with them.

Starting on Jan. 1, 2024, Medicaid will have new health plan contracts. The contracts will run until Dec. 31, 2028. Five companies put bids in to be Medicaid’s manage care plans, the three selected are: United Health Care, Nebraska Total Care and Molina Health Care.

“We hope we’ll see better communication,” Bagley said. “They [Insurance users] will have those plans which will have a better focus on the ‘whole person care,’ and not just physical and behavioral health.”

To select the three companies, Medicaid performed interviews and asked specific questions that stakeholders wanted to know the answers to during Medicaid’s listening tour in January.

For members who are also eligible for Medicare, starting on Jan.1, 2024, Medicaid will offer to them a Medicare Advantage Plan called Dual Eligible Special Needs Plans (D-SNPs).

“That allows the same plan to manage their Medicaid and Medicare benefits, so those members won’t have two places to work through. They’ll have one for both insurances,” Bagley said.

With the new contracts, dental services will be covered and integrated with physical, behavioral health and pharmacy services. Bagley said that in their first listening tour, stakeholders brought up multiple times the huge need for dental care.

“As part of that, we sat down with a lot of our dental stakeholders to try and understand what some of the barriers are,” Bagley said. “One of the things that we determined was to shift away from having a single manage care plan for dental like we do today, to work with those plans that have a ‘whole person care’.”

“I’m optimistic about the new plan going forward,” said Pediatric Dentist Dr. Jessica Meeske. “We know there is a shortage of dentists right now that are accepting Medicaid, and there are a lot of Nebraskans that have this insurance plan and they would like a place to go and have their dental needs met.”

Bagley said that as part of the new contracts, starting a year after Jan. 1, 2024, the process of credentialing healthcare providers will be simplified.

“It shouldn’t be a six-month time frame to get people credentialed,” Bagley said. “So our providers today might have to do it [credentialing] three times in three different ways, starting on January of 2025 they’ll do it one time, one way.”

“We don’t want to spend a lot of time filling up paperwork, we need to spend our time taking care of our patients,” Dr. Meeske said.

Changes will also be made to electronic visits verification.

“For folks that are involved in either personal care services or home health services, they’ll be required to have some changes on that front,” Bagley said.

He added that care and case management will be more robust.

“We recognize that’s the only way we can ensure that we are actually helping people live better lives,” Bagley said. “By actually talking to them, working with them, understanding what their personal needs are, and how we address those needs.”

NE Medicaid will start coverage for continuous glucose monitoring (CGM) devises for eligible members with diabetes on Jan. 1, 2023. The devices measure intestinal glucose levels for those with type one and type two diabetes. Bagley said the eligibility is currently being developed.

The Medicaid insurance plans vary depending on the person. According to Bagley, NE Medicaid spends $3 billion a year on those 375,000 individuals insured with them.

Bagley said Medicaid is planning to soon release a strategic plan for key initiatives. They also plan to start a new phase of community outreach to continue the conversations with the public through meetings. He added that they are thinking of doing their statewide tour every six months, to keep hearing from stakeholders, providers and Medicaid members.

Bagley already visited Lincoln, Omaha, Scottsbluff, North Platte and Hastings. Before October ends, they hope to visit South Sioux City, and Fremont. Bagley is also holding virtual meetings with stakeholders, providers, and members.

For more information about the upcoming Medicaid updates visit this website.


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