By Patricia Jones, Task Force on Poverty
In November 2018, Nebraska voters approved a measure to expand Medicaid in our state. Applications are being accepted now for Heritage Health Adult, and Medicaid benefits begin October 1.
Rural Nebraskans like those of us in Box Butte County are at a disadvantage in our ability to access health care coverage. As a population, rural residents are older, have lower incomes, are more likely to have chronic illnesses, and live further from their health care providers. Rural residents are also more likely to be self-employed or work in small businesses without insurance benefits. Rural hospitals write off significant costs for patients who are unable to pay.
Previously, lower income adults eligible for Medicaid in Nebraska either had to have children or have special medical needs like disabilities or visual impairment. Medicaid was also provided for people aged 65 or older who had fewer than $4,000 in assets but needed more care than Medicare could pay. Through the Children’s Health Insurance Program (CHIP) coverage has been provided for former foster children, pregnant women, and children age 18 and under whose families do not qualify for Medicaid but could not afford other health insurance.
The Medicaid expansion extends coverage to low-income able-bodied adults ages 19-64. Low-income is defined as those earning up to 138% of the federal poverty level. In Nebraska in 2020, that means an annual income of about $17,600 for a single adult or $36,000 annually for a household of four. For income, DHHS looks 30 days before the month in which the application is submitted to DHHS. So, if someone applied onSeptember 29, they would look at August income, the 30 days before September 1.
If you qualify for Medicaid coverage through the adult expansion group, called Heritage Health Adult, there are two benefit packages available: Basic and Prime benefits. Both benefit packages include comprehensive physical health, behavioral health, and prescription drug services.
Prime benefits include basic services plus dental, vision, and over-the-counter medications. These additional benefits are automatically available for adults who are pregnant, ages 19 or 20, or those who are medically frail. Medically frail includes people who are defined as disabled by Social Security, or who have a physical, intellectual, or developmental disability, a serious and complex medical condition, disabling mental health disorder, chronic substance abuse disorder, or are chronically homeless.
Heritage Health plans are available through three insurance companies: Nebraska Total Care, WellCare, and United Healthcare. You can change between these three companies within 90 days, or during the annual open enrollment period.
If an individual is not eligible for Heritage Health Adult, the Department of Health and Human Services (DHHS) will inform the individual of other benefits like SNAP that they may be eligible for, and their application will be sent to the federal marketplace (healthcare.gov) for consideration there. People may also appeal the decision and request a hearing to reevaluate the request.
If an individual is enrolled in Heritage Health Adult, they are reassessed automatically each year without filing a new application. The individual must let DHHS know within ten days if there is a life change, such as a new job or a change in address. With this updated information, DHHS staff will determine whether the individual is still eligible for HHA. If they are no longer eligible, their coverage with HHA will end at the end of the month that they are found no longer eligible.
Applications are being taken online at ACCESSNebraska.ne.gov. While the state is urging applications be submitted online, applicants will also be able to submit over the phone at 855-632-7633; by email, fax, or mail; or in person at a local Department of Health and Human Services (DHHS) office. The Box Butte County office is located at 411 Black Hills in Alliance, open 8:00-2:30 daily; phone 308-763-2900.
DHHS expects about 90,000 applications for the Medicaid Expansion programs, but that number may be larger due to COVID-related layoffs. Expanded Medicaid coverage will help provide health care for many in our area.