State officials drop plans for 2-tier Medicaid system

MM Curator summary


Medicaid beneficiaries in the new Nebraska expansion group will get dental, vision and OTC drug coverage without having to meet any volunteer or wellness requirements.


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LINCOLN, Neb. — State officials are dropping plans for a two-tier system to cover voter-approved Medicaid expansion in Nebraska.

The Nebraska Department of Health and Human Services (DHHS) announced Tuesday that all Nebraskans covered by the expansion will get a full range of benefits starting Oct. 1, the Omaha World-Herald reported. The announcement is a change from the earlier plans of Gov. Pete Ricketts’ administration to offer a two-tier system that would include a “basic” plan covering physical and behavioral health care services and a “prime” plan that would also cover dental, vision and over-the-counter drugs.

The two-tiered system would not have applied to those who receive benefits through the traditional Medicaid program, only those who qualify for the expanded coverage.

To qualify for prime coverage, recipients would have been required to meet work or volunteer benchmarks or participate in educational or job-training programs. They also would have had to meet with a health care provider for a wellness assessment.

Tuesday’s announcement means the state will provide the full range of benefits without the additional requirements.

The Trump administration approved Ricketts’ two-tier plan last year, prompting a lawsuit by advocacy group Nebraska Appleseed. But President Joe Biden’s administration made clear early this year that it would not approve the system.

It’s unclear how Tuesday’s announcement will affect Nebraska Appleseed’s lawsuit, but a hearing in the lawsuit was set for Monday.

Voters expanded Medicaid through a 2018 ballot measure, but the state Health and Human Services Department stalled implementation of it for nearly two years — the longest delay in the nation among states that have expanded the program. Activists placed the measure on the ballot after years of failed attempts to expand Medicaid in the Republican-dominated Legislature and strong opposition from the state’s GOP governors.

The expansion extends coverage to able-bodied, working-age adults who earn too much to qualify for regular Medicaid but too little to be eligible for tax credits to help them buy health insurance under the Affordable Care Act.


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