CMS Approves Medicaid Work Requirements for Nebraska

On Oct. 20, CMS approved a waiver that allows adult Medicaid beneficiaries in Nebraska to receive additional benefits, including vision and dental, if they participate in work requirements.  The program is set to go into effect in April 2021.

Nebraska’s new Medicaid Section 1115 demonstration called “Heritage Health Adult” is designed to create a pathway for certain Nebraska adults with newly gained Medicaid coverage to access additional benefits if they participate in certain activities to promote health and independence, according to CMS.

Arizona’s Medicaid agency, AHCCCS is now conducting virtual public forums regarding its December 2020 waiver submission to CMS.

Enrollees in Nebraska’s Medicaid expansion population will be eligible to receive benefits including dental, vision and over-the-counter drug coverage in exchange for completing engagement activities, such as working 80 hours per month, according to Healthcare Finance.

CMS Administrator Seema Verma said,

Seema Verma

The Nebraska demonstration is a unique model designed to provide a voluntary pathway to added benefits for certain adult beneficiaries who participate in wellness activities, as well as work and take part in other community engagement activities, which can help lift them from poverty and put them on a road to improved health and independence.

This demonstration applies to an important but limited population: adults who are not medically frail or pregnant, ages 21 through 64, and who are eligible under the Medicaid adult group expansion—having income at or below 138 percent of the federal poverty level. Low-income adults who are 19 or 20 years old and/or medically frail, children, pregnant women, elderly adults, and others eligible on the basis of a disability will not be affected. Additionally, Heritage Health Adult beneficiaries will not lose Medicaid eligibility if they choose not to participate in the voluntary incentive opportunity provided under this demonstration.

Work requirements have been controversial in other states. In February a federal appeals court ruled that the Trump Administration unlawfully allowed Arkansas to implement a work requirement on those covered under that state’s Medicaid expansion program, echoing a lower court ruling from 2019.

According to the Center for Law and Social Policy (CLASP) CMS should be using this time to connect people with health insurance by creating a COVID-19 special enrollment period, conducting outreach and enrollment education about the availability of Medicaid and marketplace coverage to those losing employment, or by encouraging the 12 remaining states to adopt Medicaid expansion.

Suzanne Wikle from CLASP said,

Instead, CMS officials are doubling down on their ongoing efforts to restrict people’s access to Medicaid by approving new work reporting requirements in Georgia and Nebraska.

Recent approvals by the Centers for Medicare & Medicaid Services clearly signal disagreement with critics that contend approving work reporting requirements for Medicaid during a global pandemic and a period of historic unemployment may not be in the best public interest.

The Centers for Medicare and Medicaid Services’ (CMS) approval of Arizona’s Demonstration renewal application will extend authority for Arizona to implement programs including, but not limited to:

• Mandatory managed care
• Home and community-based services for individuals in the Arizona Long Term Care System (ALTCS)
• Administrative simplifications that reduce the inefficiencies in eligibility determination
• Integrated health plans for AHCCCS members
• Payments to providers participating in the Targeted Investments Program
• AHCCCS Works – Medicaid work requirements
• Waiver of Prior Quarter Coverage for specific populations

Check out AHCCCS or The Hertel Report for remaining meeting dates and check out the AHCCCS public forum slideshow for information on recent State Medicaid Advisory Board Meeting presentation which included info on AHCCCS Works