Nebraska Revamps Medicaid Management


The Centers For Medicare & Medicaid Services (CMS) have approved a plan that will allow Nebraska to change how it manages Medicaid. The new system will roll out on January 1, 2017.

Nebraska is trying out an integrated managed care program that will operate statewide and cover physical health, behavioral health and pharmacy services for enrolled members. Nebraska will turn over operations to three private companies – UnitedHealthcare Community Plan of Nebraska, Nebraska Total Care (Centene) and WellCare of Nebraska, to administer these services.

Individuals who are currently enrolled in Medicaid will have until December 1, 2016 to read through the three plans offered by the private companies and choose one. Those who do not choose their own plan by the cut off time will be automatically assigned to a plan.

Nebraska calls the managed care program “Heritage Health”. It was first launched as a pilot program in 1995. The move on January 1, will codify the work already done through the pilot.

Nebraska has rejected Medicaid expansion as prescribed under the Affordable Care Act multiple times. However, state officials hope that a private managed care program will keep costs down for current Medicaid participants. But, there are a number of gaps in the private coverage – the managed care plan does not cover nursing home care, a number of long-term care services or dental. The state provides some payment for those services separately. Several other states also operate managed care programs for Medicaid, to varying degrees of success.

Recent census data shows that after rejecting Medicaid expansion, over 150,000 people in Nebraska remain uninsured. According to a separate report from the Nebraska Legislature’s Legislative Fiscal Office, most of those 150,000 people fall into a coverage gap whereby they do not qualify for Medicaid under current rules but also do not make enough money to afford even high-deductible plans on the insurance marketplace.