October 22, 2020

CMS Approves Nebraska Medicaid Wellness & Work Requirements

On Tuesday, October 20, CMS granted approval for Nebraska’s plan to offer enhanced Medicaid benefits to adults who participate in certain wellness initiatives and “personal responsibility activities.” The plan, titled “Heritage Health Adult,” is part of Nebraska’s Medicaid program expansion that voters approved in 2018.  This expansion, which went into effect on October 1, is expected to provide Medicaid benefits to an additional 90,000 Nebraskans.  As part of the expansion, eligible adults (ages 21 through 64) who are not medically frail or pregnant will be able to gain access to expanded benefits through this demonstration program.  All beneficiaries will have coverage for a comprehensive set of Medicaid benefits that meets federal benefit standards, including hospitalization, ambulatory care, emergency room care, maternity and newborn care, prescription drugs, and laboratory services. Additional benefits, including vision services, dental services, and over-the-counter medications, will then be available to those beneficiaries who also attend an annual health visit, complete a health risk assessment, maintain affordable employer-sponsored coverage if available, do not miss more than three scheduled health appointments in a six-month period, and participate in community engagement activities for at least 80 hours per month.  Beneficiaries that are younger than 21 or older than 64, medically frail, pregnant, or eligible on the basis of a disability already have access to the additional benefits and will not be subject to the wellness and work requirements.