How Nebraska’s Unnecessary and Complicated Medicaid Expansion Waiver Works

Nebraskans’ votes should be honored.

MedicaidTwo years ago, in November of 2018, Nebraskans voted for Medicaid expansion to provide health care coverage to thousands of our family members, friends, and neighbors. The Nebraska Department of Health and Human Services (DHHS) delayed implementing the program, keeping more than 90,000 Nebraskans from accessing lifesaving Medicaid coverage.

This October, eligible Nebraskans were finally given access to Medicaid expansion coverage and started receiving medical care. But for many Nebraskans, Medicaid expansion coverage still does not include access to dental, vision, and over-the-counter drug benefits.

Nebraska Medicaid usually covers all of these benefits. How is DHHS planning to withhold these benefits from many Nebraskans eligible for Medicaid expansion?

DHHS Unnecessarily Created a Two-Tiered Benefit System for Medicaid Expansion:

Instead of providing dental, vision, and over-the-counter drug coverage to all of those eligible for Medicaid expansion, DHHS came up with the Heritage Health Adult plan, which withholds benefits from many Nebraskans eligible for Medicaid expansion by creating unnecessary barriers. This plan–also known as Nebraska’s Section 1115 waiver–is not only complicated for those navigating Medicaid expansion, but it is also costly to implement.

Many Nebraskans spoke out in opposition to the waiver’s problematic work, personal responsibility, and wellness requirements and the punitive cuts to fundamental vision, dental, and over-the-counter drug benefits. Despite such opposition, DHHS submitted its waiver to the federal government for approval in December of 2019. After receiving 425 public comments, 424 of which were in opposition, the federal government still approved the waiver on October 20, 2020. 

What does this mean for Nebraskans?

The Section 1115 waiver implements a complicated two-tiered benefit system for the Medicaid expansion group, imposing barriers and cuts to coverage for Nebraskans seeking health care.

Unlike other Medicaid enrollees, our neighbors in the expansion group will either have Prime or Basic coverage. While Prime coverage includes all Nebraska Medicaid benefits, Basic coverage is a stripped down version of Medicaid that denies individuals dental, vision, and over-the-counter drug coverage (“Prime-Only Benefits”). Currently, only those who are 19 or 20 years old, pregnant, or determined to be medically frail by DHHS can receive Prime coverage. The remaining individuals in the expansion group are denied these benefits and receive only Basic coverage.

In order to receive the Prime-Only Benefits, those with Basic coverage will have to meet six separate requirements every six months. The Section 1115 Waiver is set to begin on April 1, 2021, but because of the way it is set up, people with Basic coverage cannot access Prime-Only Benefits until October 1, 2021 at the earliest, even if they meet all of the requirements. 

Unless exempt, Medicaid expansion enrollees in Basic coverage would have to meet the following six separate requirements to get Prime coverage: 

Beginning on April 1, 2021:

  • Participate in health risk screening upon enrollment and annually thereafter;
  • Attend a qualifying annual health visit;
  • Not miss three or more appointments in a six month period; 
  • Maintain employer-sponsored health insurance coverage; 

Beginning on April 1, 2022:

  • Report changes in circumstances that may affect access to Prime-Only Benefits within a certain time frame; and 
  • Meet community engagement requirements, also known as work requirements. 

DHHS will evaluate the requirements every six months to determine whether someone should have Prime or Basic coverage. This means that a person can be locked out of dental, vision, and over-the-counter drug coverage for six months or a year if they don’t meet these requirements.

Share your story:

Tell us your story about how the Medicaid expansion waiver will impact you:

Share Your Story

Spread the word:

At the end of October, over 15,000 people were enrolled in lifesaving Medicaid expansion coverage. Still, at least 74,000 more Nebraskans are estimated to be eligible for Medicaid expansion.

Someone you know may be eligible for Medicaid expansion. Make sure your family members, friends, and communities know about their options:

Find Free, Local Assistance

Learn more:

Check out our Medicaid expansion page to find more information on eligibility, requirements, and more. Questions? Reach out to Nebraska Appleseed’s Community Assistance Line.

Get Help

We will keep working together to protect the health and well-being of every Nebraskan. Stay up to date with us by texting ‘MYVOICE’ at 52886.

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