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Midlands Voices: Nebraska should expand Medicaid enrollment now

Midlands Voices: Nebraska should expand Medicaid enrollment now

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The writer is executive director of Nebraska Appleseed, a Lincoln-based nonprofit focusing on public policy.

Life is changing quickly across Nebraska with the spread of COVID-19. It is clear we are facing a public health challenge that is unprecedented in modern history. Nebraskans, at all levels of government, and our health care system are working hard to implement changes and use all of the tools at their disposal to get ahead of this situation. Health insurance coverage plays a significant role in ensuring that those who become ill are able to quickly access needed treatment through a primary care provider or through more significant interventions for those who need them.

Unfortunately, 90,000 of our family members, friends and neighbors are still waiting for Medicaid to be expanded. Our health care system is missing this critical tool to combat the spread and toll of this illness in our communities. Those without health insurance often do not have a primary care provider and, after the illness has progressed and spread, may need to seek treatment in an emergency room. Uninsured Nebraskans have expressed concern about how they can cope and do their part without the security health insurance provides.

Without critical diagnosis and treatment, those who contract the coronavirus will have a significant impact on all Nebraskans, including those fortunate enough to be insured. Simply put, this impacts all of us.

Gov. Ricketts and the Department of Health and Human Services have been doing incredible work to provide critical information and assistance to all Nebraskans. Now, more than ever, we need to work together to advance positive systemic change, including expanding Medicaid.

While the Ricketts administration has decided to pursue a complicated Medicaid expansion waiver scheme, it does not prevent the immediate expansion of the program. To expand Medicaid, states must submit paperwork and seek federal approval, but they can begin covering those who are eligible before paperwork is approved. Under federal rules, states can submit to the federal government what is known as a Medicaid State Plan Amendment (SPA) to quickly expand Medicaid. Nebraska filed an initial SPA in April 2019, and that SPA can be amended to expand Medicaid with an effective date of Jan. 1, 2020, nine months before the current proposal. Nebraska can immediately begin enrollment, covering people who have medical bills retroactively for 90 days. Those enrolled can be covered under what is known as a fee-for-service model until the new population can eventually be folded into Medicaid managed care.

All of these actions that are permitted under federal law allow for immediate coverage and can help address, in part, the impact of a looming public health crisis.

This faster, clearer path to Medicaid expansion has always been available. It is expressed by the language of Initiative 427 and is well known to the governor and the state HHS leadership. In fact, we need only look to Idaho for an example of a more expedient implementation. Idaho voted by ballot to expand Medicaid the same day as Nebraska. Idaho proceeded under a SPA, open enrollment started in November 2019, and coverage started Jan. 1, 2020. The difference between the two states’ experiences is that one state urgently moved to expand Medicaid under a SPA process, while the other proposed an unneeded and complicated waiver scheme that necessarily meant a major delay in the start of Medicaid expansion.

Expanding Medicaid immediately would require effort and work, but we should all be very clear on two points. One, we find ourselves facing a public health crisis with tens of thousands of Nebraskans uninsured because our leaders chose to delay the will of the people in expanding Medicaid. Two, the law allows Medicaid to be expanded and our family, friends, and neighbors to be covered right now.

The only question is, in the face of great need, will our leaders choose to equip our communities and the health care system with this powerful tool?

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