We mentioned earlier this week about the public’s need for certainty in regard to COVID vaccination. That same obligation for clarity and stability applies to Medicaid expansion in Nebraska.
The path toward expansion of health coverage to Nebraska’s working poor has been bumpy and uncertain for years. This month, federal regulators raised question marks about the series of requirements Nebraska has set for people to receive full Medicaid coverage. That’s a switch from the Trump administration, which cleared the way for the requirements.
If that remains the federal government’s stance, and it certainly appears that will be the case, Nebraska should move forward with full Medicaid coverage for those eligible. It’s way past time for Nebraska to end the uncertainty that’s long surrounded this program.
Medicaid expansion, after all, was approved through a statewide vote of the people in November 2018, receiving 53% approval. The vote required Nebraska to expand its Medicaid program as allowed under the federal Affordable Care Act. Those newly eligible were working-age adults without disabilities whose incomes fall below 138% of the federal poverty level. That is equal to $16,753 for a single person or $34,638 for a family of four. The proposal, supported editorially by our newspaper, aimed to extend health coverage to an estimated 90,000 Nebraskans.
In the wake of the 2018 vote, the Ricketts administration took two years to implement Medicaid expansion and adopted a two-tier system by which people would need to meet various work and community engagement requirements in order to receive full coverage. That approach spurred complaint from many Nebraskans, who emphasized that such a tiered system wasn’t part of the 2018 vote.
“We did not vote for a two-tiered system, work and wellness requirements, and changes to retroactive eligibility,” Dr. Ali Khan, dean of the College of Public Health at the University of Nebraska Medical Center, wrote during a public comment period about the proposed policy. “Please honor the will of the citizens of Nebraska.” Khan is a former assistant surgeon general with the U.S. Public Health Service.
Under the Nebraska Constitution, a decision directly taken by the people carries particular weight in the governance of the state. The Constitution underscores that point by making it quite difficult for the Legislature to overturn any decision made via voter initiative or referendum — a two-thirds majority is required.
In other words, elected state officials must show particular deference to the people’s decision.
The latest uncertainty in Nebraska’s Medicaid approach came this month when the federal Centers for Medicare and Medicaid told the state’s Medicaid officials that the agency is looking to withdraw approval for a state plan requiring that low-income, working-age adults work, volunteer or do other specified activities for 80 hours a month to get full benefits. Nebraska’s policy raises “serious concerns,” wrote Elizabeth Richter, acting administrator for the federal agency.
Nebraska officials will respond to Richter’s letter, but the language she employed clearly indicates that federal approval of a two-tiered system is unlikely under the Biden administration.
Medicaid expansion has been marked by more than enough uncertainties. Nebraska officials should prepare to move forward, clearly and efficiently, to provide full coverage to those who qualify.