The Nebraska Department of Health and Human Services recently submitted a waiver request to federal officials for implementing Medicaid expansion using a two-tiered benefits system with work and wellness requirements.

The DHHS Division of Medicaid and Long-Term Care submitted its application for a Section 1115 Demonstration Waiver for Medicaid expansion last Friday.

The state’s proposed Heritage Health Adult expansion program would have Basic and Prime tiers.

“Most beneficiaries will begin with the robust package of services available in the Basic benefits package,” wrote Matthew A. Van Patton, director of MLTC at DHHS, in a letter sent to the Centers for Medicare and Medicaid Services. “By completing certain wellness, personal responsibility, and community engagement activities, beneficiaries can earn additional, Prime benefit – which consist of dental, vision, and over-the-counter medications. Unlike other states, everyone who meets underlying eligibility criteria will receive at least the robust Basic benefits package.”

In a statement, DHHS says its plan will result in better and more cost-effective health outcomes for Nebraskans it will be serving.

“The structure of HHA will improve population health, patients’ self-management of their own care, patient and provider experiences of care, and reduce the per-capita costs of health care,” Van Patton said.

Nebraska Appleseed, a nonprofit advocacy group that has filed a lawsuit against DHHS for delaying implementation of Medicaid expansion, said in a release the state is ignoring comments from hundreds of Nebraskans opposed to adding the work and wellness requirements.

“The Department is continuing to delay implementing Medicaid expansion by experimenting with a Section 1115 waiver that imposes additional barriers and reduced benefits,” said Molly McCleery, program director for health care access at Appleseed. “It is clear that Nebraskans voted for basic access to care, not a complicated experiment that creates barriers to that access.”

The federal government will have its own comment period on Nebraska’s waiver request. The state plans to expand Medicaid on Oct. 1, 2020, with an application period beginning in August depending timely federal approval.

Find more information, including a copy of the waiver request, at dhhs.ne.gov/Pages/Medicaid-Expansion.aspx.