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Lincoln – The Department of Health and Human Services, Division of Medicaid & Long-Term Care (DHHS), continues its work to expand Medicaid to low-income, able-bodied adults of working age (19 to 64 years old).
Applications will begin to be accepted on August 1. Benefits will begin on October 1. Expansion will happen on time.
DHHS plans to utilize a demonstration waiver of Section 1115 of the Social Security Act to allow beneficiaries the opportunity to earn enhanced Prime benefits by participating in wellness, personal responsibility, and community engagement activities. Prime benefits will be available to all participating Nebraskans. Newly eligible Nebraskans who are 19 or 20 years old, pregnant, or medically frail will be eligible for an exception to the wellness, personal responsibility, and community engagement activities. Our approach better achieves the purpose of the Medicaid program by incentivizing positive activities that will improve health outcomes and encourage life successes for participants. This 1115 waiver must be approved by the Centers for Medicare and Medicaid Services (CMS).
Due to the COVID-19 pandemic, CMS has focused considerable time and attention towards addressing this unprecedented public health emergency. As a result, CMS has notified DHHS that approval of Nebraska's 1115 expansion demonstration waiver will not be finished in time for Nebraska's planned expansion effective date of October 1.
DHHS is moving forward with expansion with the planned tiered benefits to allow the state to meet our current timeline to accept applications on August 1, 2020 and begin benefits on October 1, 2020. Participating Nebraskans will able to earn additional, Prime benefits after the 1115 waiver is approved and the additional components of the 1115 waiver are implemented.
Most newly eligible Nebraskans will start with the Basic benefits package, which is a comprehensive benefits package that includes the following services:
Newly eligible Nebraskans who are 19 or 20 years old, pregnant, or medically frail will receive the Prime benefits package, which is the Basic benefits package plus:
With the future approval of the 1115 demonstration waiver, beneficiaries receiving the Basic benefits package will have the opportunity to earn the enhanced Prime benefit package.
The Department will implement expansion on time with a benefit structure that allows future implementation of the wellness, personal responsibility, and community engagement incentives that are ultimately in the best interest of beneficiaries and providers.