LINCOLN — Nebraska Appleseed filed a lawsuit Wednesday seeking to move up the date when about 94,000 low-income Nebraskans could gain Medicaid coverage.
The suit asks the Nebraska Supreme Court to order state Medicaid officials to implement voter-approved Medicaid expansion by Nov. 17.
That’s nearly a year earlier than the Nebraska Department of Health and Human Services planned to start offering the coverage. The plans called for kicking off the new coverage on Oct. 1, 2020.
James Goddard, director of Appleseed’s economic justice program, said the suit was filed on behalf of Mellissa Ely and Gerald Brown, two Nebraskans with serious health conditions for which treatment is critically needed. Both would gain coverage and care under the expansion.
“This suit seeks to ensure our family members, friends and neighbors receive Medicaid coverage this year and that Nebraska tax dollars are brought back to support our health care system,” Goddard said.
But Taylor Gage, a spokesman for Gov. Pete Ricketts, called the lawsuit a “distraction from effectively delivering Medicaid expansion for the people.”
He said that federal approval of the expansion is pending and that several steps need to be completed before coverage can be offered to the new group. Those include technology build-outs, contract negotiations and regulatory changes.
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The lawsuit argues that the delay in implementing expansion violates Initiative 427, the Medicaid expansion law approved by voters in 2018. That law requires state officials to maximize federal funding for the expansion.
But delaying the implementation of expansion means that the state will miss out on a period of time when the federal government would pay 93% of the cost of coverage. Under the federal Affordable Care Act, the federal share will drop to 90% on Jan. 1.
Based on state estimates, the later start date would mean $149 million less in federal funding for the state.
Initiative 427 requires the state to cover additional low-income Nebraska adults, as allowed under the ACA.
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.
Expansion would allow those groups to gain Medicaid coverage if their incomes are below 138% of the federal poverty level — $16,753 for a single person or $34,638 for a family of four. Noncitizens are not eligible now and would remain ineligible under expansion.
According to the lawsuit, Ely is a 46-year-old Lincoln woman with several health conditions that prevent her from working. She does not qualify for Medicaid now but could under the expansion.
Ely had a heart attack on July 6 and received two stents and several prescriptions. Her partner paid for the first prescriptions, but Ely does not know whether she can continue the medications or get follow-up care because she is uninsured.
In addition, she has had previous strokes, suffers from arthritis in her hands and has a lump on her thyroid that needs medical assessment.
Brown, a 51-year-old Lincoln man, works but makes less than $1,000 a month. He does not qualify for Medicaid now but could under the expansion.
He has health problems that need treatment, including a shoulder injury that causes chronic pain and chest pain. He also needs a colonoscopy and dental care.
HHS officials plan to use a two-tier system to cover the newly eligible group. Under the plan, they would have different benefits and requirements from other Medicaid patients. To get full coverage, they would have to work, care for a family member, volunteer, look for work, attend college or take part in an apprenticeship.
Following federal approval of the expansion itself, the state will have to seek federal approval of a so-called 1115 demonstration waiver to adopt the two-tier program. That process can take several months. Specifics of the coverage provided under each tier would be worked out with federal officials.
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