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Nebraska not budging from 23-month timeline for launching Medicaid expansion

LINCOLN — Ashley Anderson had been six years without health coverage when she told her story as part of the campaign for a Medicaid expansion ballot measure in Nebraska.

The Omaha woman talked of not being able to see a neurologist or get her anti-seizure medications checked. Of uncontrolled seizures that kept her from working full-time or earning enough to pay for health insurance.

Of side effects she might escape with a different medication. Of unpaid ambulance and emergency room bills.

But Medicaid expansion has yet to begin, nearly 1½ years after voters approved it, and Anderson is still struggling.

Ashley Anderson

“We’ve been doing all we can to keep her medication filled,” said her mother, Shannon Casey. “Not much has changed.”

Official plans still call for launching the expansion on Oct. 1. That would be 23 months after the November 2018 vote requiring Medicaid to cover some 94,000 low-income adults in Nebraska.

No other state has taken more than 14 months from approval to launch. That includes Utah and Idaho, whose voters approved ballot measures at the same time as Nebraska voters. It also includes at least 10 states that sought federal approval to waive traditional Medicaid rules, as Nebraska has requested.

Advocates blame Gov. Pete Ricketts, an ardent foe of expansion, for the pace of progress.

“It’s inexplicable to me other than ideological,” said State Sen. Machaela Cavanaugh of Omaha. “It is purposefully slow-walking the will of the voters of the state of Nebraska.”

Ricketts bristled at the suggestion that Nebraska could move faster to implement expansion.

“Not one person has seriously approached us to say I’ve looked at your project plan, here’s where you can tighten this timeline,” he said. “Not one person.”

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Ricketts also rejected advocates’ calls to speed up the launch in light of the coronavirus epidemic. State Medicaid officials are on track to meet the current start date, he said, but they do not have the ability to start sooner.

Among other tasks, he said, they still have to build up their network of doctors and other providers, finish developing and testing enrollment software, get contracts signed with the private companies that manage Medicaid and rewrite state regulations. HHS officials said the state’s methodical approach will pay off in less confusion and stress for providers.

“If we were to change that now it would push it back to at least December,” Ricketts said, “so that’s not a feasible option.”

But Molly McCleery of Nebraska Appleseed argued that speeding up Medicaid expansion would help Nebraska weather the coronavirus epidemic and the economic havoc it has caused.

“Coronavirus changes things in that it shines a light on the fact that we need as many people covered as possible,” she said. “We want to make sure we’re using every tool we have to fight coronavirus.”

People without the means to pay for health care are less likely to go to the doctor if they have symptoms of COVID-19, the disease caused by the coronavirus, and less likely to be tested. They also are more likely to have untreated medical conditions that make them more vulnerable, Cavanaugh said.

Under federal coronavirus legislation, states can use their Medicaid programs to pay for coronavirus testing of uninsured people. Nebraska has not sought approval for that option so far. The federal legislation does not cover treatment of the disease.

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Jessica Schubel, a senior policy analyst with the Center on Budget and Policy Priorities in Washington, D.C., said soaring unemployment because of coronavirus also increases the need for Medicaid expansion, because it means more people losing employer-provided health insurance.

“Medicaid serves as a lifeline for low-income Americans at times such as this,” she said.

Nebraska has seen more than 66,000 workers file first-time jobless claims over the last three weeks. Each week has set a new record as businesses struggle with restrictions aimed at slowing the spread of the virus.

Medicaid expansion would provide coverage for working-age adults without disabilities or minor children whose incomes fall below 138% of the federal poverty level — $17,236 for a single person or $35,535 for a family of four.

Currently, single adults and couples without minor children cannot qualify for Medicaid, no matter their income level. Also barred are parents and disabled people with incomes higher than the current Medicaid cutoff. Noncitizens are not eligible now and would remain ineligible under expansion.

The coronavirus already has forced some changes in Nebraska’s Medicaid expansion plans.

HHS officials announced Friday that the Centers for Medicare and Medicaid Services has been too occupied dealing with the virus to review and approve the state’s plan for a two-tier system of expansion benefits. Approval had been expected this month but now will be at least six months away.

As proposed, the system would have provided most newly eligible Medicaid patients with dental, vision and over-the-counter medication benefits if they complied with eight requirements, including wellness, personal responsibility and “community engagement.”

The change announced Friday means newly eligible patients, with some exceptions, cannot get those “prime” benefits, which are part of the traditional Medicaid program.

However, they will get so-called basic benefits, which include physical and mental health services and prescription drugs. Nebraska officials said the higher tier of benefits will be available once federal officials can review and approve the state’s proposal.

The exceptions are people considered medically frail, pregnant women and young adults ages 19 and 20. Those groups will get all of the traditional Medicaid benefits.

Ricketts and state Medicaid officials said the expansion remains on track for an Oct. 1 launch date, with applications starting Aug. 1.

One key expansion advocate said she supports the state’s launch timeline, given the coronavirus pandemic.

Sen. Sara Howard of Omaha, the Health and Human Services Committee chairwoman, said she worries that HHS workers could not cope with the stress of speeding up the expansion.

Although the state has filled the new positions planned for the expansion, she said the coronavirus has taken its toll on employees, many of whom have been required to continue working from their offices.

“I don’t want to put any more strain on their system,” Howard said. “I think that’s the most pragmatic and practical approach.”

April photos: Nebraska faces coronavirus

Messages of solidarity and thanks on Easter
British leader, recovering from virus, praises Health Service; pope, most pastors preach to empty pews

NEW YORK (AP) — Christians around the world celebrated Easter Sunday isolated in their homes by the coronavirus while pastors preached the faith's joyous news of Christ's resurrection to empty pews.

In Britain, Prime Minister Boris Johnson, the first major world leader to test positive for the virus, paid an emotional tribute to the country's National Health Service following his release from the hospital, saying its doctors and nurses had saved his life "no question." He especially thanked two nurses who stood by his bedside for 48 hours "when things could have gone either way."

The strangeness of this Easter was evident at the Vatican. St. Peter's Square, where tens of thousands would normally gather to hear Pope Francis, was empty of crowds, ringed by police barricades. Francis celebrated Easter Mass inside the largely vacant basilica. In his address, the pope called for global solidarity to confront the "epochal challenge" of the pandemic. He urged political leaders to give hope and opportunity to the millions laid off work.

In the U.S., some pastors went ahead with in-person services despite state or local bans on large gatherings. In Louisiana, a pastor who is facing misdemeanor charges for holding services despite a ban on gatherings said people from every state and all but one continent attended his Easter service Sunday morning.

"My hope is not in a vaccine for a virus, but all my hope is in Jesus," the Rev. Tony Spell said during the service shown online from Life Tabernacle Church in the city of Central.

President Donald Trump had said he planned to watch an online service led by the Rev. Robert Jeffress of the Southern Baptist megachurch First Baptist Dallas, although the White House wouldn't confirm whether he did. The pastor, a staunch ally of the president's, mentioned Trump in his remarks.

"We are going to get through this crisis with your continued strong leadership and the power of God," Jeffress said.

In their own Easter message, Trump and his wife, Melania, paid tribute to the medical professionals, first responders and other essential workers striving to combat the pandemic.

In Europe, countries used roadblocks, fines and other tactics to keep people from traveling over an Easter weekend with beautiful spring weather.

The Italian government said weekend police patrols resulted in more than 12,500 people being sanctioned and 150 facing criminal charges for violating lockdown measures.


On the hopeful side, officials said Italy recorded the lowest number of new coronavirus victims in three weeks, with 431 people dying in the past day to bring its total to over 19,800. It was the lowest day-to-day toll since March 19.

As hard-hit countries like Italy and Spain see reduced daily virus infections and deaths, economic pressures are mounting to loosen the tight restrictions on daily life.

Southern Europe and the United States, whose death toll of more than 22,000 is the world's highest, have been the recent focal points of the pandemic. But coronavirus hot spots have been shifting, with new concerns rising in Japan, Turkey and Britain, where the death toll passed 10,000.

Uncertainties loomed about the months ahead, with a top European Union official suggesting people hold off on making any summer vacation plans. More than 1.8 million infections have been reported and over 114,000 people have died worldwide, according to Johns Hopkins University. The U.S. has the highest numbers, with over 555,000 confirmed cases.


In the United States, about half the deaths are in the New York metropolitan area, but hospitalizations are slowing in the state, and other indicators suggest that lockdowns and social distancing are "flattening the curve" of infections.

Dr. Anthony Fauci, the top U.S. infectious disease expert, said the economy in parts of the country could be allowed to reopen as early as next month.

He told CNN's "State of the Union" that "rolling reentry" will be required based on the status of the pandemic in various parts of the country.

Car-horn hallelujahs 'broke Satan's eardrums' at King of Kings parking lot Easter service

Hallelujahs rang out Easter morning not from voices at King of Kings Church but from vehicle horns all across the parking lot near 116th and I Streets in southwest Omaha.

Appearing on a 12-by-20-foot video screen, the Rev. Greg Griffith implored parents and children listening at home or sitting in their vehicles because of the coronavirus to celebrate the good news of the resurrection of Jesus Christ.

“Open your windows and doors at home, run outside and shout, ‘He is risen,’ ” Griffith exhorted. “In your cars, honk your horns.”

Griffith paused during the ensuing jubilee, but his words would’ve been drowned out anyway by the cacophony of sound that rose from the parking lot. A mighty ruckus was raised, despite a bitter wind and incessant rain.

“I love that we just broke Satan’s eardrums,” Griffith said a minute later.

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King of Kings Church began in 1962 with 75 members and is affiliated with the Lutheran Church–Missouri Synod, a mainline Protestant denomination. On this Easter, like no other in memory, with churches empty due to concerns about social distancing during the COVID-19 pandemic, King of Kings found a way to bring its flock together.

“We also had services (outside) for Palm Sunday,” Griffith said. “My sense is it was just a great way to bring a little joy. As much as it could be with social distancing, it felt like Easter.”

The church held two parking lot services on Palm Sunday, at 9 a.m. and 11 a.m. The staff started planning for three Easter services, but the interest led them to schedule services at 7 a.m., 9 a.m., 11 a.m. and 1 p.m.

Vehicles, mostly SUVs and minivans, began rolling through the rain into the parking lot for the 9 a.m. service about 8:30 a.m. Volunteers in orange and lime-green ponchos were spaced throughout the parking lot waving flashlights as if guiding airplanes into position.

About 140 vehicles were admitted for each service. The vehicles were parked at least 6 feet apart, and the congregation, for the most part, kept their windows rolled up.

The volunteers walked between the vehicles with signs telling everyone to tune to 95.5 FM to hear the hymns, readings and the sermon. At one point, a church security vehicle was summoned to jump-start the battery of a car belonging to a reporter who had foolishly let his battery run down.

The Rev. Mark Zehnder spoke to the congregation about how proud he was of them during the pandemic. A recent Red Cross blood drive at King of Kings had seen every time slot filled.

“It’s just awesome to see what’s going on in this church at a very difficult time,” Zehnder said. “I have not been able to hug my grandchildren in over six weeks. When it’s all said and done, we’re going to see a community, and a church, like never before.”

Griffith reminded the congregation that anyone needing counseling or wanting someone with whom to pray should contact King of Kings. The church has several trained counselors ready to teleconference with people struggling with separation and anxiety, he said.

“One of our goals (with the Palm Sunday and Easter services) is that we believe the Omaha community is going to need to see each other and gather together,” Griffith said. “We will get through this because Jesus is in control.”

April photos: Nebraska faces coronavirus

A 19-year-old's life of hardship, promise, then tragedy


From the time of his birth in a refugee camp to the day police pulled his body out of Carter Lake, Wuor Wiyual's life was full of hardship. And opportunity.

In the end, hardship won. On Friday, Omaha police identified the 19-year-old new American citizen and classified his death a suicide. News circulated among friends and family, shocking everyone who knew him.

"It's beyond tragic to me that he's gone," said his former Bryan High coach and American government teacher, Terrence O'Donnell. "I'm just devastated and I know everybody who had him as a part of their lives is devastated."

An autopsy was scheduled for this weekend. No funeral arrangements have yet been made. A gofundme campaign for his family was started on Saturday.

When reached Friday, Wuor's brother Kier, a senior at Bellevue East High School, said their mother, Buk Deng, was in shock and hadn't been able to utter a word.

Wuor, whose name is pronounced "war," was born in a refugee camp in Ethiopia. His parents had married earlier that year. His mother was 16.

In an essay Wuor would later write to get a college scholarship, he said his parents, who'd fled South Sudan, had promised their parents in Africa that they would get their children to college.

"College is something I've always dreamed of going to," he wrote in December 2017.

Wuor wanted to be a teacher. Like a lot of boys growing up in America, though, Wuor first had designs on being a professional athlete. He was most interested in football, but everyone said he should play basketball. That sport proved hard initially for a gangly, constantly growing boy who at the time of his death was 6-feet-8 and 165 pounds.

In his 2017 essay, Wuor described not making his seventh-grade basketball team, a disappointment that caused him to turn his focus from football to basketball and steeled his will to make it the next year.

At Bryan High, he began playing on the freshman B team but worked his way to the varsity squad by his senior year. O'Donnell saw Wuor as "a late bloomer" and once told him that his ceiling was "very, very, very high."

That dream of basketball stardom drove him, O'Donnell said, but Wuor wanted most of all to be a teacher.

The scholarship essay explains why. Growing up in Omaha as the oldest of five children, Wuor took on responsibility for his family amid stresses including domestic violence and poverty. In seventh grade, his family was robbed of the kids' TV and PlayStation and $500 cash his mother had hidden in a box.

His teachers at Bryan Middle School mobilized. They replaced the lost items and gave the children "the best Christmas ever."

"It was the first time in my life I've woken to presents," Wuor wrote.

In his essay, Wuor describes his hero — his mother. How she worked hard, "nearly 15-hour shifts then coming home, taking care of the kids." How she stayed strong and didn't give up, qualities he said "could take you far."

Those were the very qualities O'Donnell and Wuor's Central Community College coach, John Ritzdorf, saw in him.

"I'll talk about Wuor all day long," said Ritzdorf. "I'm not ashamed to say it — he's a favorite of mine."

Ritzdorf described Wuor as a student whose Christian faith was important, who placed value on family and was "proud of his mom," and who was a model teammate whether on the court or on the bench.

"He was themost excited guy on the bench, jumping up and down after someone else made a really good play."

Ritzdorf said Wuor embraced his opportunities at "CCC," as the college is called.

"You could tell he appreciated it," Ritzdorf said. "Nothing was a chore for him. He was super genuine and funny and caring."

The basketball season wrapped up right as the novel coronavirus was starting to upend daily life. As the campus outside Columbus began to shut down, Wuor went back home.

Back to the Bellevue apartment where his mother and four younger siblings live. Back to his job at QuikTrip. Back to helping around the home.

Wuor's brother said it wasn't easy. Wuor's computer wasn't working right for his online classes. He wanted to be more independent, as he had been in college. And he had been drinking. This caused friction with his hero, his mother.

The two had words. Wuor left for his night shift on March 27. He didn't come home. He sent text messages to several people, sounding distressed. A police report described them as "suicidal statements." On March 28, Wuor's 2017 Ford Fusion was pulled from Carter Lake.

On Thursday, members of the Omaha Fire Department dive team found his body.

"No words. Just Deep Wounds," Kier wrote on Facebook.

He'd looked up to Wuor. His big brother had been his role model. Kier, too, plays basketball. He, too, has college hopes.

"He always knew how to make people laugh," Kier said.

And he always pitched in. In that scholarship essay, Wuor wrote about helping distribute food and clothing to the needy and cleaning a thrift store.

"Just me experiencing getting help," he wrote, "makes me want to give back to others."

He apparently didn't give himself the chance.

O'Donnell, his Bryan coach, was reeling last week.

"This is such a shock and blindsided tragedy," O'Donnell said. "Everything about him was confidence to keep working hard and persevere. He persevered through extraordinarily difficult circumstances. ... I can't wrap my head around what could be in his mind. Something he couldn't overcome."

erin.grace@owh.com, 402-444-1136


This is a stressful time. It can be particularly tough for young people whose fresh futures might seem out of reach and certainly now are disrupted by the novel coronavirus.

Mike Kavan, a psychologist and professor at the Creighton University School of Medicine, said loneliness and isolation can cause problems for young people.

He said it's important to check in, engage and offer support.

"It's so important that when we talk about social distancing," he said, "we should be talking about physical distancing — and social connecting. We need to keep people connected."

If you need help, please reach out. You can call the Disaster Distress Helpline, part of the National Suicide Prevention Lifeline, at 800-985-5990. — Erin Grace