​Medicaid Expansion in Nebraska

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On November 6, 2018, Initiative 427, the expansion of the Medicaid-eligible population, was approved by Nebraska voters. This initiative requires the state to submit a State Plan Amendment (SPA) to include Nebraskans under the age of 65 whose income is at or below 138 percent of the federal poverty level in the state’s Medicaid-eligible population. Presently, the eligible Medicaid population remains the same as prior to the ballot measure being passed.

Read the full initiative.

To implement Initiative 427 as it is written, the Division of Medicaid and Long-Term Care (MLTC) must complete amendments to current waivers, contracts and regulations. The Division will also need to complete information systems and technology updates, such as ACCESSNebraska, phone systems, and the Medicaid Management Information System (MMIS), as well as hire and train additional staff in the field and central office.

Initiative 427 requires the State to submit a State Plan Amendment to the Centers for Medicare and Medicaid Services (CMS) by April 1, 2019. Other activities and timelines may change and impact expansion’s effective date.


Implementation Targets

All dates are approximate and depend upon a variety of factors, including identifying expansion funding.  Medicaid is committed to making the implementation of expansion as transparent as possible, and will post frequent updates on progress on this page.

Medicaid Expansion Timeline

Frequently Asked Questions - Last Updated December 13, 2018

Fiscal Impact Analysis of Initiative 427 - Published September 21, 2018


February 15, 2019


Medicaid Expansion in the Governor’s Budget Recommendations

It is shaping up to be a busy session for the Nebraska Legislature this year. This tends to be the case in the first year of each session. Of all the issues facing the Legislature this session, creating a state budget is among the most important. Without it, state agencies and programs—including Medicaid—will not have the funds to continue our work into the next state fiscal year.

On January 15, Governor Ricketts introduced his budget recommendations to the Legislature for state fiscal years 2019-2020, which run from July 2019 to June 2021. His recommendations balanced a number of different priorities, including property tax relief, education, and Medicaid expansion.

As discussed in DHHS’s fiscal impact analysis on Medicaid expansion (linked above), the federal government is expected to cover 90 percent of costs related to medical services for the eligibility group outlined in Initiative 427. The State of Nebraska will still be responsible for the remaining 10 percent of these costs associated with the expansion group. Other costs are expected to be matched 75/25 and 50/50.

Governor Ricketts’ budget recommendations include details on how his administration proposes paying for the portion of expansion-related costs that the federal government will not cover. In the recommendations are $69.1 million in state general funds and $520.5 million in federal funds appropriated to the Department of Health and Human Services for the purposes of Medicaid expansion. More detailed information on the governor’s budget recommendations can be found at the link below:


In the coming weeks, the Legislature will begin putting together its own budget for state fiscal years 2019-2020, and we will share more information on this when it becomes available.

February 1, 2019


NET Features Nebraska Medicaid’s Expansion Efforts

Earlier this week, Fred Knapp of NET featured the Nebraska Medicaid team’s efforts to expand Medicaid in Nebraska, as directed in Initiative 427.

Knapp interviewed Dr. Matthew Van Patton, director of the Division of Medicaid and Long-Term Care, about the current status of expansion, the considerations involved in covering a new population, and more.

Here are a few excerpts from the piece:

Whenever Medicaid expansion comes online, Van Patton said he wants to get it right. And he said that direction comes from Ricketts, who opposed Medicaid expansion before voters approved the initiative. “I can tell you exactly what the governor told me. He said, ‘Matthew, we’re going to honor the will of the people and we’re going to get this thing done, and we’re going to do it right and we’re going to take our time to do it right,’ he said.

Van Patton said it would be counterproductive to rush implementation. “If you’ve got a benefit but you can’t access it because you haven’t built the adequate provider network to accommodate the health of that population, that’s the risk you take by rushing it,” he said.

And he said people who have contacted the department asking about expanded Medicaid appreciate being told where things stand. “When you speak candidly to them and you tell them exactly what you’re doing, and you tell them the elements you’re working on that are required to make it a full, functioning program and when it’s ready to go we’re going to have a good experience for folks, they very much appreciate that,” he said.

For more, read or listen to the full story.

Also, be sure to follow DHHS on Facebook, Twitter, and Instagram for more updates on Medicaid expansion and other agency efforts.

-Matt Litt, DHHS Communications and Legislative Services Director


January 25, 2019


How does the state plan amendment process work?

As we discussed in our last blog, the State will need to amend its state plan in order to be able to provide Medicaid coverage to the eligibility group identified in Initiative 427. This process is commonly referred to as submitting a state plan amendment, or SPA.

Here’s how the amendment process works.

After the need for a SPA has been identified, Medicaid staff begin drafting four documents:

  • the pages of the state plan which are being amended;
  • a tribal summary (which summarizes the changes to the state plans for the Native American tribes in Nebraska);
  • a fiscal impact assessment; and
  • a transmittal form.

Once these items are drafted and reviewed, the tribes are given 30 days to review the documents and provide feedback. Following this review window, MLTC will send the SPA package to the Centers for Medicare and Medicaid Services (CMS), the federal agency in charge of administering Medicaid.

CMS has 90 days from the date the SPA is received to review and approve or deny the SPA. If CMS has any questions for the state, their 90-day window is paused until the question is answered.

Once approved by CMS, the changes to the state plan will be effective the date specified in the SPA.

As mentioned, this will be one piece of many in implementing Medicaid expansion.


January 15, 2019

In his State of the State address on January 15, Gov. Ricketts noted that Medicaid expansion, also known as Initiative 427, will be funded in his new two-year budget. “In November, voters approved Medicaid expansion, and my budget recommendation reflects the vote of the people of Nebraska,” said Gov. Ricketts.  “Right now, the Medicaid team is working to fulfill the direction of the initiative to file a state plan with the federal government by April 1st.” 


January 11, 2019

What’s the state plan, and why does it need to change for expansion?

The action called for in Initiative 427 was for the State to amend its current state plan to extend Medicaid coverage to adults earning up to 138 percent of the federal poverty level. Some members of the public may have read their ballot and, while they understood the ballot measure’s goal, didn’t understand the steps toward that goal.

In today’s post, I’d like to clarify the steps that come before implementing Initiative 427. Namely, we would like to explain what the state plan is and why it must be changed in order to implement Medicaid expansion.

A state plan is a contract between a state and the federal government which outlines how the state operates its Medicaid program. State plans outline details such as who the program covers, what services are covered, and more. Nebraska’s state plan can be viewed here.

Every state is required to have a state plan for two main reasons: 1) ensures the state is following all federal rules and regulations surrounding Medicaid and 2) allows states to draw from federal funding in order to pay for a portion of Medicaid expenditures.

If a state is found to be operating its Medicaid program outside the guidelines of the federally approved state plan, it will lose access to federal funding for Medicaid.

Section 2 of the Nebraska state plan outlines the individuals who are currently eligible for Medicaid in Nebraska. The population identified in Initiative 427—adults under age 65 who earn up to 138 percent of the federal poverty level—is not currently included in Section 2. In other words, Nebraska cannot draw on federal funding to cover the Initiative 427 group without amending its state plan.

In our next post, we will share more information on how the state plan amendment process works.



December 13, 2018

Dr. Matthew Van Patton, Director, MLTCWelcome to the DHHS Medicaid Expansion Blog. I’m Dr. Matthew Van Patton, director of the Division of Medicaid and Long-Term Care. My team and I will provide regular updates on current activities and other topics related to Medicaid expansion in Nebraska.

As mentioned at the top of the page, Initiative 427 approved a plan to expand the group of Medicaid-eligible Nebraskans to include adults under age 65 whose income is at or below 138 percent of the federal poverty level. The initiative provided the Division with a deadline to submit a State Plan Amendment to the Centers for Medicare and Medicaid Services, but provided no guidance for the completion of other tasks that will be necessary to implement the initiative as it is written. We are currently working to identify those tasks and planning.

Expansion involves a number of different steps which may be less familiar to some members of the public. These steps include technology updates, contract updates, and others. This blog looks to provide information on what these steps mean.

Along with information on general topics, this blog will provide updates if and when changes occur, as well as other milestones and events.

This page will also share useful documents related to the expansion process, such as the FAQ document posted above. We hope this page is a helpful resource for all those with questions about Medicaid expansion in Nebraska.

If you have questions, please feel welcome to send them to DHHS.MedicaidExpansionQuestions@Nebraska.gov.