Election 2018 Medicaid Expansion

A yard sign promoting Initiative 427, the Medicaid expansion initiative.

By the time Nebraska’s Medicaid expansion goes live Oct. 1, 2020, nearly two years will have elapsed since voters approved the initiative.

That’s a long wait, with Nebraska’s rollout appearing to be the longest among states expanding since the Affordable Care Act was passed. For the estimated 94,000 low-income Nebraskans awaiting Medicaid eligibility, it may feel like an eternity.

Then again, the Nebraska Department of Health and Human Services, responsible for administering the expanded program, is playing catch-up on after well-documented problems upgrading its computer systems.

The Journal Star editorial board shares the state’s opinion that this rollout be done right the first time, given its importance to users. That said, two years seems quite long to implement. This mixed bag, of course, will fully satisfy neither proponents nor exponents of expansion.

One thing all parties should agree upon is the intent of Medicaid.

The program was never designed as a permanent health insurance solution for workers. Instead, it’s supposed to fill in the gaps as these people aim to earn higher-paying, more stable employment rather than the perverse outcome of staying underemployed to stay eligible for coverage, as the previous setup could make happen. Expanding eligibility should alleviate that to some extent.

In the end, the Nebraskans who can now be served by Medicaid next year need a functioning system for the critical coverage they’ve lacked. However, those who have delayed treating a health condition because of finances will likely be displeased with the October date, rather than Jan. 1, 2020, as supporters anticipated.

Nebraska smartly elected not to walk into the trap – and impending legal defeat – of instituting rigid work requirements, as Kentucky did.

This state’s community engagement mandate, which would take effect in the second year, wouldn’t fully remove those who didn’t comply from coverage; it would merely downgrade them from the prime plan to the basic. However, organizers of the initiative warn such a plan may violate the ballot language approved by Nebraska voters.

Furthermore, though a budget has yet to emerge from the Nebraska Legislature’s Appropriations Committee, Gov. Pete Ricketts has proposed fully funding Medicaid expansion – nearly $20 million in general fund money – for the upcoming fiscal year beginning July 1. This new start date, however, pushes its rollout into the following fiscal year.

That yet-to-be-answered question and new timeline also affect more than just the state budget. Before Initiative 427 passed, Lancaster County commissioners estimated its approval would free up more than $2 million from the county’s general assistance medical fund.

We’re glad to finally see the state’s Medicaid expansion plan on paper – and that it’s mostly reasonable. However, we know the next 18 months will bring plenty of questions. What matters most is that low-income Nebraskans gain access as quickly as possible to the reliable health coverage that’s long eluded them.

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