Timetable, Contents of Nebraska Medicaid Expansion Still Uncertain

Jan. 29, 2019, 6:45 a.m. ·

Matthew Van Patton stands by Medicaid expansion plans. (Photo by Fred Knapp, NET News)

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Nebraska officials are working on expanding Medicaid, which voters approved in last November’s election. But it’s a complex process, and exactly what benefits Nebraskans can expect, and when they'll be available, remains uncertain.

The goal of Medicaid expansion sounds simple: provide health care coverage to an estimated 94,000 low-income Nebraskans – people with incomes up to 138 percent of the federal poverty line. That’s about $17,000 for a single adult; $29,000 for a family of three.

But achieving that goal requires lots of planning. In his Jan. 15 State of the State speech, Gov. Pete Ricketts said, “In November, voters approved Medicaid expansion and my budget recommendation reflects the vote of the people of Nebraska. 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 1.

That work is going on two blocks away from the Capitol, at the Department of Health and Human Services in the State Office Building. In a stark, off-white conference room, Director of Medicaid and Long-term Care Matthew Van Patton stands by flip chart-sized papers taped to the wall outlining the process and describes some of the challenges.

Van Patton said one challenge is figuring out the needs of people who will be signing up. “We know what our population is that we’re currently serving. We don’t have a good way of at this point quantifying what that population’s going to look like coming into it,” he said.

For example, Van Patton said, 72 percent of the current Medicaid population are children, pregnant women or new mothers. “if you’re looking at women and children, what kind of network does that dictate? Natural logic is pediatricians, ob-gyns, general practitioners,” he said.

The state contracts with four managed care organizations who have their own networks to provide those services. But Van Patton said those networks will have to change, to serve the new population. “They need to go build in more internal medicine contracts or more general practitioners, or maybe its onboarding cardiology or other specialists that maybe have not been part of the program at this juncture,” he said.

The state also has to decide what it will cover. For example, dental coverage is offered to current Medicaid recipients, even though it is beyond the core coverage required by the federal government. Van Patton said it’s yet to be determined if expanded Medicaid will include dental coverage. “I don’t have anything concrete to tell you that this is in, this is out, this is up, this is down,” he said.

Van Patton said the state could also ask the federal government for permission for other benefits, such as a wellness program, obesity management, or smoking cessation benefits.

The need to work with the federal government adds to uncertainty about when Medicaid expansion will take effect. The initiative set an April 1 deadline for the state to submit a plan. But there’s no such deadline for the feds.

That’s why Van Patton says he can’t say for sure when people who are eligible will be able to use the health coverage promised by expanded Medicaid. “There’s no official ‘go-live’ date because we’re still trying to figure what all of our work points will be and how long each of those processes will be and estimate when we can hit that go-live date that we put in that state plan,” he said.

Asked if he had a guess, Van Patton said, “At this juncture, I would tell you it’s certainly not going to be this year, and in all likelihood, it’s going to be somewhere further into 2020.”

Ricketts’ budget proposal recommends spending about $18 million in state funds this fiscal year, matched by $152 million in federal funds, to expand Medicaid, “assuming an aggressive January 1, 2020 implementation date.”

Asked if his “further into 2020” means later than January 1, Van Patton said he’s reluctant to speculate because there are so many moving parts.

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.

A spokeswoman for the department says a projected go-live date will be included in the plan submitted to the federal government April 1.

To see the Department of Health and Human Services' page on Medicaid expansion, click here.