Feds approve Nebraska's two-tiered Medicaid expansion setup

OMAHA, Neb. (AP) — Low-income residents who qualify for expanded Medicaid coverage in Nebraska will have to work, volunteer or take classes or get job training if they want access to certain health-care services starting in 2022, state officials said Tuesday.

Gov. Pete Ricketts said the federal government has approved Nebraska's request to impose additional requirements on people who want coverage for vision or dental services or over-the-counter drugs.

Nebraska submitted a two-tiered proposal to the federal government, with a prime plan that includes those extra services a basic plan that doesn't. The basic plan offers coverage for physical and behavioral health care services and prescription drugs. Recipients will also have to meet with a health care provider for a wellness assessment in 2021.

People who are 19 or 20 years old, pregnant or considered medically frail will get prime coverage without having to meet the additional requirements. State officials said the requirements are aimed at able-bodied, working age people.

“We’re really trying to incent people to do the right thing for their health,” Ricketts said at a press conference.

Nebraska was among several conservative states where state lawmakers and governors declined to expand Medicaid, only to see the issue go to voters. Ricketts and his GOP predecessor, Dave Heineman, both argued that expansion would be too costly for the state, and lawmakers rejected six attempts in as many years to adopt it as an optional part of President Barack Obama’s 2010 health care law.

State officials expect Nebraska's expanded enrollment to rise to about 90,000 within a few years.

In a statement, advocates for Medicaid expansion criticized the two-tiered approach as a way to restrict coverage for people.

“This is not what Nebraska voters intended (when they approved it in 2018) and is not good health policy,” said Molly McCleery, a health care advocate for Nebraska Appleseed, a group that fought for the expansion. “Nebraska does not need a complicated waiver system that makes it harder for people to access the care that they need.”

The announcement also drew criticism from the OpenSky Policy Institute, a tax policy think tank that has previously questioned the administrative costs of the state's plan.

“The approved plan isn’t a fiscally responsible way to provide comprehensive health coverage to Nebraska’s families," said Tiffany Friesen Milone, the group's policy director.

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