One More Year Before Most Nebraskans Can Qualify for Dental, Vision, OTC Drugs Under Expanded Medicaid

Oct. 20, 2020, 4:40 p.m. ·

Gov. Pete Ricketts speaking Tuesday (Photo by Fred Knapp, NET News)

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Most Nebraskans on the newly expanded Medicaid program will have to wait another year before they can be eligible for dental, vision, and over-the-counter drug coverage.

Nebraskans voted in November, 2018 to expand Medicaid to able-bodied low-income adults, with incomes less than about $18,000 a year for an individual, or $30,000 for a three-person household.

The state implemented expansion three weeks ago, and so far, officials say, about 25,000 people have applied, and just over 14,000 have been found eligible, out of about 90,000 who are ultimately expected to enroll.

So far, most people are eligible for basic benefits covering physical and behavioral health and prescription drugs. Pregnant women, 19 and 20 year-olds, and medically frail people get more benefits.

But for most new recipients, the state asked the federal government, which pays 90 percent of the cost of the expansion, for permission to make coverage of dental and vision services and over-the-counter drugs dependent on applicants’ meeting certain requirements.

State officials say originally the plan was to begin that coverage next April, but when the coronavirus pandemic hit, federal permission was delayed. Tuesday, Gov. Pete Ricketts announced the state’s plan has been approved.

“Now, we will be able to add on that second-tier plan that we have for the plan, to really be able to promote the kind of behaviors we want to look for with regard to wellness, personal responsibility and community engagement,” Ricketts said

Nate Watson of the Department of Health and Human Services said people can begin the process of qualifying next April 1. Initially, they will have to pick or be assigned a primary health care provider, see that provider once a year, and work with their health plan to get a health risk screening. If they meet those criteria, they can qualify for the expanded coverage as soon as next October 1.

Starting in 2022, they’ll have to meet an additional requirement of spending at least 80 hours a month in “community engagement” activities, such as working, going to school, or volunteering for a charity. They’ll also lose the extra coverage if they miss three or more appointments without a good reason.

Reacting to the announcement, Molly McCleery of Nebraska Appleseed, which advocates for low-income people, called the two-tiered system “a step in the wrong direction.” McCleery said it is legally suspect, and said Appleseed would study a possible legal challenge, which Ricketts said he’s confident the state could withstand.

Seema Verma, administrator of the federal Centers for Medicare and Medicaid Services, participated briefly in Ricketts’s news conference via video call and applauded the state’s plan.

“These reforms in particular represent undeniable gains for the people of the state of Nebraska. However, as surely as night follows day, there will be those who are bent on weaponizing the legal system to thwart state innovation. But rest assured President Trump will defend the rights of states to design their own programs and work to ensure that Americans are in charge of their health, not special interest groups,” Verma said.

Correction: an earlier version and the audio version of this story contained an incorrect year for when Medicaid expansion passed in Nebraska. It was 2018.