Medicaid Delay Discussed; Briefing Held on Mead Ethanol Plant

Some state senators expressed frustration with yet another delay in Nebraska’s Medicaid expansion. And the head of the Department of Environment and Energy briefed lawmakers on the situation at a controversial closed ethanol plant near Mead, Nebraska on Thursday.

Nebraska voters approved expanding Medicaid in November, 2018 and coverage began in October of last year. But under a waiver approved by the Trump administration, the state put in place a “two-tier” system. Everyone who qualified got basic tier medical coverage. But to get the so-called premium tier -- vision, dental, and over-the-counter drug coverage -- people had to meet additional requirements, beginning with “wellness and personal responsibility” activities like getting a health risk screening and showing up for an annual health visit, and progressing to “community engagement” -- working, studying, or volunteering.

Last April, the Trump administration announced a delay in approving the plan because of the pandemic. It approved the plan in October, subject to an implementation plan submitted in December, and the state said people could start earning premium coverage this April. Two weeks ago, the Biden Administration said it reconsidering the requirements approved by the Trump Administration. Wednesday, the state said that would produce further delay.

Speaking to the Appropriations Committee Thursday, Kevin Bagley, the state’s director of Medicaid and long-term care, attributed the delay to the federal Centers for Medicare & Medicaid Services, or CMS.

“It’s become clear to us in recent conversations with CMS that they’ll not provide a decision on the waiver implementation plan we submitted in December 2020 in time to begin the wellness and personal responsibility requirements on April 1, as previously planned,” Bagley said.

Bagley promised to work to toward resolving the issue as soon as possible.

Sen. Robert Hilkemann asked Bagley if the state would simply drop its plan for a two-tier system.

“So the optional services that were going to be provided if people were part of the wellness program, are they going to be provided to everybody at this point now?” Hilkemann asked.

“They will not,” Bagley replied.

Sen. Anna Wishart asked Bagley why not.

“You’ve got two options: you can battle it out with the feds, or, from my understanding, you could just not go down that waiver path, and right now, just offer that premium tier to every person, with frankly, a lot less administrative overhead…why not do that?” Wishart asked.

“Well, like I mentioned, moving that Medicaid ship is a really, really difficult thing to turn. And so, even if we were to take that direction, I think we would be realistically probably six months out to be able to make that happen,” Bagley responded, mentioning not only CMS, but also the need to renegotiate contracts with providers.

Wishart expressed dissatisfaction:

“It’s frustrating to hear that there is now going to take six months to put somebody on a plan and expand their services, to get vision, which by the way is critical for working, if someone has vision issues, dental is very important for somebody’s overall health, so that’s frustrating,” she said.

And Appropriations Committee chair Sen. John Stinner said he thinks lawmakers want Bagley to act as quickly as possible, despite any difficulties working with the federal government.

“I get the fact CMS is a different animal, but I would explore trying to get to the next tier as quickly as possible for all the reasons that were stated in this committee. And I think you’ll hear it from the Legislature,” Stinner said.

Attempts to get reaction from CMS were not immediately successful.

Molly McCleery of Nebraska Appleseed, an advocacy group that helped lead the initiative petition drive to expand Medicaid, said “We continue to be disappointed that Nebraska is pursuing a plan that denies critical benefits. This is not what voters intended.”

Also Thursday, Jim Macy, director of the Nebraska Department of Environment and Energy, briefed members of the Natural Resources Committee on the situation at a now-closed ethanol plant near Mead, about 40 miles north of Lincoln. The AltEn plant’s use of pesticide-treated seed corn to make ethanol sparked complaints from neighbors of odor and concern for their health.

The department ordered the plant to shut down Feb. 4, and ordered a cleanup after a frozen pipe burst Feb. 12, releasing millions of gallons of wastewater.

In his briefing for senators Thursday, Macy defended his department’s regulatory oversight of the plant.

“The agency’s been out there a lot over many years and we’re trying to our job in having facilities in compliance, in particular this one,” Macy said.

Sen. Mike Groene challenged Macy.

“Your duty is compliance, right, not noncompliance? How did it get this bad, if you were checking this plant over the last 20 years?” Groene asked.

As part of his answer, Macy pointed to the plant’s unique character.

“There’s no other ethanol plant that’s using a treated seed corn as their input stock,” he said.

Asked about groundwater pollution, Macy offered some reassurance.

“We actually just received some results back that we’re still doing a little bit of analysis work on that. And, it doesn’t look too bad and that’s from groundwater monitoring wells on site. So our plan is to further evaluate that. We’re not going to take a long time to do that. But it doesn’t look terrible,” he said.

Macy’s department has been criticized for declining to attend a town hall meeting on the plant next Monday. He said he looks forward to meeting with local residents after the current emergency is past.

Editor’s note: Christina Stella of NET News helped on this report.