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Understanding Medicaid Expansion

Understanding Medicaid Expansion

By Governor Pete Ricketts

July 24, 2020


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Nebraska voters passed Initiative 427 to expand eligibility for Medicaid services from the State.  The Nebraska Department of Health and Human Services (DHHS) has been working hard to implement the expanded coverage, which will be called Heritage Health Adult.  Thanks to the team’s focus and effective management, enrollment will open as planned on August 1st and services will begin on October 1st.


Reaching this point has taken a tremendous amount of work.  As directed by the ballot initiative, DHHS filed the required state plan amendments with the federal government on April 1, 2019.  Along the way, DHHS has been working to secure federal approvals for the new program, building the technology platforms required to manage the program, and pulling together the network of providers and doctors needed to deliver services.


DHHS estimates that about 90,000 Nebraskans will sign up for the expanded Medicaid program.  Nebraskans with an annual income under 138 percent of the federal poverty level are eligible to apply.  For individuals, the income threshold is about $17,600 and for a family of four it is around $36,000.  People in this income bracket, ages 19 to 64, qualify for coverage through Heritage Health Adult.


Under our plan that meets federal requirements, folks who sign up will receive a robust and comprehensive package similar to private insurance that includes physical health coverage, behavioral health coverage, and prescription drugs.  Nebraskans who are 19-20 years old, pregnant, or medically frail will receive the comprehensive package noted above, plus dental, vision, and over-the-counter drug coverage. 


The State of Nebraska has submitted a waiver application to the Centers for Medicare and Medicaid Services (CMS).  CMS communicated earlier this year that the waiver review is taking longer than originally expected due to their ongoing pandemic response.  Once the waiver is approved, all Nebraskans participating in Heritage Health Adult can qualify for dental, vision, and over-the-counter drug benefits.


The majority of Nebraska’s Medicaid benefits and services are provided through managed care organizations, also called Heritage Health plans, including for newly eligible expansion participants.  Heritage Health plans assist participants with accessing services, providing reminders about appointments, and paying providers for their services.


To make expansion possible, DHHS has completed the significant technology buildout required to manage the new program.  A great deal of computer coding was needed to prepare the DHHS legacy (1977) computer system for the new Heritage Health Adult population.  These complex system modifications took lots of time to perform correctly and required close coordination between the DHHS programming and IT teams.  DHHS has been working with Medicaid providers to test systems to make sure they continue to work properly.  


Pulling together an expanded and robust provider network has also been a big part of Medicaid expansion.  It’s important that the Medicaid provider network has the capacity to handle the 90,000 newly-eligible Nebraskans.  Historically, women and children have accounted for 73 percent of Medicaid recipients.  However, many of the individuals joining the Heritage Health Adult Plan will be adults who did not qualify for Medicaid prior to expansion.  This means we have needed to recruit more general practitioners and other specialists to serve this new population.  DHHS has worked with health plans to expand provider networks in order to meet the particular health care needs of this new population of Medicaid recipients.


Nebraskans can enroll online for Medicaid expansion starting August 1st at  The website will be the easiest and most efficient way for Nebraskans to sign up.  Applicants can create an online account with ACCESSNebraska to sign up and check their application status.  Nebraskans can also call 855-632-7633 to enroll. 


As the enrollment period begins, we ask everyone to be patient.  We expect there to be a lot of interest.  To provide additional enrollment capacity, DHHS has hired and trained 68 additional eligibility staff to help with applications.  The agency is also working with two vendors to provide additional assistance to maintain our high quality of customer service.  With the potential for 90,000 people to sign up for Heritage Health Adult in the coming weeks, our team is going to be very busy.  We will monitor performance and make adjustments to overcome any challenges that may arise.


If you have questions about Medicaid expansion, DHHS is the best way to learn more about the eligibility or services that will be offered through the Heritage Health Adult plan.  The agency has provided information on Medicaid expansion on its website at  If you have questions on other matters, you can email me at or call 402-471-2244.