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Medicaid Expansion Update: Newly eligible adults to receive benefits by Oct. 1 deadline

Staff Writer
Syracuse Journal-Democrat

The Nebraska Department of Health and Human Services (DHHS) is on track to begin offering benefits through Medicaid Heritage Health Adult Expansion on October 1, 2020.  The state will begin accepting applications on August 1, 2020, through AccessNebraska.ne.gov or at the nearest DHHS office.

Heritage Health Adult expands Medicaid to low-income, able-bodied adults of working age (19 to 64). Low-income individuals are those earning up to 138 percent of the federal poverty level.

Medicaid expansion enrollees will receive Basic benefits through a managed care program which integrates physical health, behavioral health, and pharmacy benefits into a comprehensive, coordinated program.

DHHS plans to utilize a demonstration waiver of Section 1115 of the Social Security Act to allow Medicaid expansion beneficiaries the opportunity to qualify for enhanced Prime benefits by participating in wellness, personal responsibility, and community engagement activities. Prime benefits include Basic services plus dental, vision and over-the-counter medications.

As the federal Centers for Medicare and Medicaid Services (CMS) has been focused on the COVID-19 outbreak, the 1115 waiver has yet to receive final approval from CMS. This final approval is necessary in order to offer Medicaid enrollees the opportunity to implement the Prime services program. However, Prime benefits are automatically available for eligible 19 and 20 year olds, pregnant women and medically frail individuals.

DHHS remains focused implementing Medicaid expansion and ensuring necessary processes are in place, services are available, and those qualifying know how to access the care and services.