Medicaid program changes proposed

The Health and Human Services Committee heard testimony March 6 on two bills that would make changes to Medicaid provision in Nebraska.

LB261, introduced by Grand Island Sen. Mike Gloor, would adopt the Medicaid Insurance for Workers with Disabilities Act. Gloor said the goal of the bill is to assist people with disabilities to stay employed and independent while retaining Medicaid coverage under certain circumstances.

The bill would require payment of medical assistance on behalf of a person with a disability who is employed and has a family income of less than 250 percent of the federal poverty level.

Allowable assets for participation in the program would be:
• $10,000 for a family of one;
• $15,000 for a family of two; and
• $15,000 for a family of three plus $25 per additional individual.

For individuals and families with income at 100 percent of federal poverty guidelines, the bill would allow a premium to be established using a sliding fee of not more than 7 percent of a recipient family’s countable unearned income plus 3 percent of earned income.

The state Department of Health and Human Services (DHHS) would be required to:
• provide training about the program to appropriate staff;
• conduct outreach and education about the benefits of the program;
• submit a report to the Legislature and governor on a biennial basis; and
• designate nonprofit employment networks that have benefit specialists that meet federal program requirements.

Gloor said the state’s current program is underutilized and needs to be better understood by DHHS workers and recipients.

“We have a program; it’s just poorly used,” he said.

Becki Koehler of Goodwill Industries testified in support of the bill, saying it would reduce fears among individuals with disabilities that working will jeopordize their medical coverage.

“They strive to earn a paycheck and to find a purpose in life through work,” she said. “[But] they still live with the fear that their life-sustaining Medicaid coverage will be cut.”

Lynn Redding of Grand Island, who described herself as a person with a disability, said she turned down a promotion out of fear of losing coverage of her medication, which costs several hundred dollars a month.

“Medicaid is the only way that I can afford my medications,” she said. “Working is important … but my health is also important. I know the empowering effect that working has on people with disabilities.”

No one testified in opposition to LB261.

Gloor also introduced LB338, which would amend the Uniform Credentialing Act and the Health Care Facility Licensure Act to prohibit discrimination by licensed health care facilities and licensed health care professionals against people eligible for medical assistance or covered by Medicaid.

Under the bill, a licensed health care facility or health care professional could be subject to disciplinary action if found to discriminate against a person with Medicaid coverage or eligibility. Such a finding would be the result of a complaint made to DHHS that is reviewed upon application for renewal of licensure.

A health care facility or health care professional providing care as a patient-centered medical home would be exempt from the bill.

Gloor said the potential increase in Medicaid participants resulting from new mandates associated with federal health care reform – along with the expansion being considered by the Legislature – could increase discrimination against Medicaid patients by providers due to low reimbursement rates.

“My concern is that they are going to show up for the party and be told that there is no room, or that [they are] not welcome now,” he said.

Kerry Winterer, CEO of DHHS, testified in support of the bill. He said the department expects an increase in Medicaid participants among newly eligible individuals and is concerned about a shortage of providers willing to serve them.

“All Nebraska citizens should be able to access quality health care,” he said.

Hastings dentist Jessica Meeske testified in opposition to the bill, saying improved access for Medicaid recipients is more complicated than LB338 suggests.

Addressing the uneven allocation of Medicaid patients among providers must be addressed, she said, adding that greater collaboration between the Medicaid and public health divisions at DHHS also would help.

“It’s not as simple as getting enough (providers) to see patients,” Meeske said.

The committee took no immediate action on either bill.

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