Disability waiver assessment bill expanded, advanced

A measure that would require training for Medicaid waiver assessment interviewers was expanded and advanced to the final round of debate April 8.

LB958, introduced by Omaha Sen. Machaela Cavanaugh, would require that the state Department of Health and Human Services’ assessment tool used to determine functional eligibility, service needs and service tier assignments for Medicaid waiver participants be administered by an employee or contractor trained in clinical interviewing techniques.

Sen. George Dungan of Lincoln offered an amendment during select file debate April 8 that would add the amended provisions of his LB773, which would expand the state’s Prenatal Plus Program and eliminate its scheduled sunset date.

The program covers the cost of prenatal services for pregnant women eligible for Medicaid or the Children’s Health Insurance Program who are determined by a health care provider to be at risk for negative maternal or infant health outcomes. Those services began in January 2025 and are scheduled to expire June 30, 2028.

Dungan’s amendment would remove the sunset date, extend reporting requirements to 2034 and expand services to include a minimum of two breastfeeding support sessions. A provision in the original measure to extend program services to eligible mothers for up to 60 days postpartum was not included in the amendment in order to eliminate the proposal’s fiscal impact.

The Dungan amendment was adopted 42-0.

Omaha Sen. Ashlei Spivey offered an amendment to include the amended provisions of her LB701, introduced last session. Those provisions would require DHHS to reimburse providers for trained doula services, at rates determined by the department, by Jan. 1, 2029. Doulas provide emotional, physical and information support before, during and after labor and childbirth.

The department would establish a group of stakeholders and experts to develop an implementation plan, to be submitted no later than Jan. 1, 2027.

Spivey said the measure would have no General Fund fiscal impact because DHHS would determine doula reimbursement rates, which would be paid from the vital statistics subfund of the Health and Human Services Cash Fund.

Nebraska has some of the highest infant and maternal mortality rates in the country, Spivey said, and expanding Medicaid coverage to include doula services is one way to reverse that trend by preventing the need for expensive medical interventions.

“This is a really great, proven opportunity for how we can do just that,” she said, adding that both of the state’s Medicaid managed care organizations currently are operating pilot programs involving doula services.

Sen. Ben Hansen of Blair supported the amendment. Reimbursing doula services would save the state money in the long run, he said, by providing emotional support to pregnant women and reducing complicated labors and deliveries.

Ralston Sen. Merv Riepe agreed that doulas serve a function, but said he could not support the amendment. The federal government likely will be reducing Medicaid reimbursements, he said, and Nebraska should “slow down” the expansion of Medicaid services.

“Enough is enough … we have to be fiscally responsible,” Riepe said.

The amendment was adopted on a vote of 32-11.

Another Spivey amendment, adopted 32-5, added provisions of her LB1033. Those provisions would require DHHS to make crisis assistance payments under the federal low-income home energy assistance program of no more than $800 per program year, while allowing higher payments under extenuating circumstances.

Following adoption of the amendments, lawmakers advanced LB958 to final reading by voice vote.