LINCOLN — State officials expect that one in three low-income Nebraskans added to Medicaid under a state expansion plan would not qualify for full coverage.

Those would be people who fail one or more of eight special requirements outlined in a draft plan released Friday by the Nebraska Department of Health and Human Services.

The draft offers more details about a two-tier system that officials unveiled in April for some 94,000 Nebraskans who could gain Medicaid coverage under a voter-approved ballot measure.

The system, called Heritage Health Adult, would have different benefits and more stringent requirements, including work requirements, than traditional Medicaid. To implement the two-tier system and its work requirements, Nebraska will have to get a waiver from the federal government.

The draft plan listed Dec. 15 as the target date for submitting the waiver application, with coverage to start Oct. 1 next year. Medicaid officials have scheduled four public hearings on the plan over the next few weeks.

Molly McCleery of Nebraska Appleseed urged Nebraskans to turn out and raise their concerns at the hearings. She sharply criticized the state’s proposal, particularly the work requirements, which she said have been shown in other states to be “expensive, burdensome and legally suspect.”

“Nebraskans are needlessly waiting for lifesaving coverage while the department chooses to experiment with a … waiver that is incredibly confusing and imposes additional barriers and reduced benefits,” she said.

State Sen. Adam Morfeld of Lincoln, who led the petition drive that put Medicaid expansion on the November 2018 ballot, called the state’s plan the “epitome of big government.”

“It adds tens of millions of dollars of unnecessary red tape that flies in the face of the will of the voters,” he said.

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The Trump administration has encouraged states to implement work requirements for Medicaid recipients, and almost 20 states are in various stages of trying to do so.

Nebraska Medicaid officials, in a statement, said they have had “extensive discussions” with federal officials about their plan that have gone “quite well.”

“We anticipate and expect approval by April 2020,” the statement said.

But work requirements for Medicaid have been problematic for the first adopters.

In March, a U.S. judge blocked work requirements in Arkansas and Kentucky, ruling that the measures undermined the program’s mission of providing health care for the needy. New Hampshire suspended its work requirements in July, and they were later blocked by a judge.

Last week, Arizona officials suspended plans to require about 120,000 people to work, volunteer or go to school to receive Medicaid benefits, citing court decisions that have gone against similar mandates in other states.

Under the Nebraska draft plan, newly eligible Medicaid patients would start with a basic level of coverage. The coverage would include physical and mental health care and prescription drugs but not dental or vision care or over-the-counter medications.

To qualify for the prime level of coverage, patients would have to meet wellness, personal responsibility and “community engagement” requirements. Compliance would be checked every six months, and failing to meet a personal responsibility requirement would bar patients from prime coverage for 12 months.

Community engagement requirements could be met by working, looking for work, caring for a family member or foster child, volunteering, attending college or taking part in an apprenticeship.

The wellness requirements include a health risk screening and an assessment of social determinants of health, filling prescriptions routinely and having laboratory work done as prescribed. They also include going in for an annual physical and choosing a primary care provider.

The personal responsibility requirements include not missing three or more medical appointments in a 6-month period, not dropping private health insurance coverage and promptly notifying Medicaid of any changes that might affect a person’s coverage.

The 2018 ballot measure required Nebraska to expand its Medicaid program as allowed under the federal Affordable Care Act. Those newly eligible are working-age adults without disabilities or minor children whose incomes fall below 138% of the federal poverty level — $16,753 for a single person or $34,638 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.

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Martha Stoddard keeps legislators honest from The World-Herald's Lincoln bureau, where she covers news from the State Capitol. Follow her on Twitter @StoddardOWH. Phone: 402-473-9583.

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