NDN Nebraska Department of Health and Human Services

The Nebraska Department of Health and Human Services held a public meeting Thursday night at the Norfolk Public Library to give an overview of the state’s plan to implement a voter-mandated expansion of Medicaid.

Nate Watson of the DHHS said in a presentation to a crowd of about 20 people the department has a “quadruple aim” of improving the health care system for Medicaid recipients and providers, reducing costs and improving the overall health of Nebraska.

Recipients of the expanded Medicaid coverage, known as “Heritage Health Adults,” or HHAs, will have two health coverage options depending on their circumstances.

All recipients will be eligible for the basic package, which includes comprehensive medical and behavioral health coverage and prescription drug coverage.

Watson said not only does the basic package meet federal requirements, but the Nebraska plan is even more comprehensive.

“The basic package is comparable and in some cases better than what some people would receive through private insurance,” Watson said.

The much more expansive prime coverage package also includes dental, vision and over-the-counter medication coverage, but recipients must qualify for it.

Those eligible for the prime package automatically include those considered medically frail, 19- and 20-year-olds and pregnant women who qualify for Medicaid.

Medically frail, Watson said, is defined as having complex health needs, including serious and long-term medical conditions and disabilities, chronic substance abuse and mental and developmental disabilities.

However, Medicaid recipients also may qualify for the prime package by participating in a series of wellness initiatives, personal responsibility activities and community engagement. Those initiatives include choosing a primary care providers and regularly attending appointments.

Community engagement activities will include being employed or volunteering for 80 hours per month, attending an accredited post-secondary school, taking care of children, elderly or disabled relatives and some state programs.

Some exemptions also will be available for community engagement requirements.

Two attendees gave a testimony criticizing and commenting on the proposed Medicaid expansion.

Dr. David Hoelting, a physician from Pender, spoke on behalf of a number of medical associations and said he was concerned that the basic package is not enough for most people, and that dental and vision care is essential for overall health.

“A lot of health issues start with dental problems,” Hoelting said. “We feel it would be cost-effective to include dental with this to prevent serious problems down the line as a result of a lack of dental care. ... We feel the prime package should be the starting point.”

Hoelting also said that many of those covered under the expanded system are already working adults and may have trouble meeting all of the requirements needed to receive the prime benefits.

“In the state of Montana, they have a system where if more than 5% of people get dropped, they stop the work requirements,” Hoelting said. “We’d like to see a cap for the number of people that can drop off so we can get that straightened out.”

Watson said he was not in a position to debate the Medicaid proposals and didn’t offer any responses to the testimonies beyond answering technical questions.

The Medicaid expansion is in an open comment period, and anyone may submit comments to the DHHS website. If the federal government approves Nebraska’s plan, it is scheduled for implementation in October 2020.

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