Nebraska Medicaid Expansion Set to Change Eligibility


Proposal seeks to provide different benefits and more stringent requirements than traditional Medicaid.

State officials in Nebraska are currently seeking approval from the Centers for Medicare and Medicaid Services (CMS) for a 2-tier benefit system to expand Medicaid to approximately 94,000 more low-income Nebraskans.

The Medicaid plan, known as the Heritage Health Adult Program, is set to be added to the current Heritage Health Program. It provides different benefits and more stringent requirements than traditional Medicaid, including work requirements.1

The program will only include people who are newly eligible for Medicaid under the expansion guidelines, such as adults with incomes up to 138% of the poverty level who would not have been eligible without expansion. Newly eligible Medicaid patients under Prime Coverage would get dental, vision, and OTC medication benefits only if they complied with a number of requirements.1

Parents with minor children are eligible for Medicaid with a household income of up to 63% of the poverty level, approximately $16,222 for a family of 4 in 2019. Non-disabled adults without dependent children are ineligible for Medicaid, regardless of how low their income is.1

Nebraska’s plan will also end retroactive coverage for most Medicaid patients.1

Starting in year 2, enrollees will have to fulfill a work requirement in order to qualify for Prime Coverage. For 80 hours each month, they will need to either be working (or participating in job seeking activities through the state), going to school, volunteering for a public charity, or serving as a caregiver for a relative.1

At the start of 2020, 37 states had adopted Medicaid expansion under the Affordable Care Act, including Idaho and Utah, which implemented the expansion on January 1, 2020, and Nebraska, where the expansion was adopted but not yet implemented.2

After Nebraska voters approved the Medicaid expansion ballot measure in November 2018, the state delayed implementation until October 1, 2020, to allow time for it to seek a Section 1115 waiver to implement expansion.

The plan will continue despite the recent resignation of the state Medicaid director, Matthew Van Patton, who as head of the Department of Health and Human Services Division of Medicaid and Long-Term Care, had been an advocate for the voter-approved Medicaid expansion.3

The final version of the states’ Heritage Health proposal was submitted to CMS in December 2019. After collecting public comments about the proposal, CMS will review it over the coming months. The department has an anticipated start date of October 1, 2020.


  • Norris, Louise. Nebraska and the ACA’s Medicaid expansion. Published December 14, 2019. Accessed January 22, 2020.
  • Rudowitz, Robin. Medicaid: What to Watch in 2020. Published January 17, 2020. Accessed January 22, 2020.
  • Stoddard, M. Nebraska Medicaid director resigns, but plans for two-tier expansion program continue. Published January 13, 2020. Accessed January 22, 2020.

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