Recent Medicaid policy changes could affect coverage for some Nebraska patients, including adults enrolled through Medicaid expansion and certain lawfully present noncitizens.
As patients begin to receive Medicaid notices or ask how the changes affect their coverage, providers can help by understanding the basics and directing patients to the right resources.
“The biggest change to the Medicaid program is the implementation of new community engagement requirements,” says Tiffany Joekel, vice president of government affairs for Nebraska Medicine. “These new requirements require adults who are eligible for the Medicaid expansion program – in Nebraska, that’s called Heritage Health Adult – to participate in community engagement activities for 80 hours a month.”
“Community engagement requirements” is the official term for rules requiring certain individuals to participate in qualifying activities such as work, school, or volunteering. Although the requirements extend beyond employment, they are commonly called “work requirements,” including on the Nebraska DHHS website.
Three changes to watch
1. Work requirements for Medicaid expansion adults.
Nebraska’s work requirements went into effect May 1 for adults ages 19 to 64 enrolled through Medicaid expansion. Qualifying activities may include work, school, job training, volunteering, or other approved activities totaling 80 hours in a month. Some patients may qualify for exemptions, including those who are pregnant, medically frail, disabled, caring for a child or person with a disability, participating in substance use treatment, or meeting other listed criteria.
2. Changes to Medicaid eligibility for certain lawfully present noncitizens.
Starting Oct. 1, new federal regulations began restricting Medicaid eligibility for some noncitizens. “Medicaid eligibility is really limited to those with green cards,” Joekel says. “These changes don’t apply to pregnant women or children, though.”
3. More frequent renewals for Medicaid expansion members.
Federal guidance also calls for eligibility renewals every six months for Medicaid expansion adults, instead of once a year. Joekel says more frequent reviews may increase “churn” in the program, meaning some eligible patients could lose coverage because of missed notices or incomplete paperwork.
Why this matters for providers
You probably won’t know whether a patient qualifies for Medicaid through expansion or another eligibility category. Patients may not know either.
That makes clear, simple direction especially important when patients ask about work requirements, exemptions, or possible loss of coverage.
The greatest risk for many patients may be administrative disenrollment – losing coverage because they did not receive, understand, or submit required information.
What providers can tell patients
The simplest message is to encourage patients to make sure the Nebraska Department of Health and Human Services (DHHS) can contact them.
“Patients should reach out to DHHS to ensure they have the most up-to-date contact information,” Joekel says. “The department will reach out to them if they need further information.”
You can also remind patients to watch for letters, texts, emails, or other communication from DHHS and respond by the deadline listed in the notice. Patients who think they may qualify for an exemption should review DHHS resources and complete any required forms.
Medical frailty and other exemptions
Patients with complex medical needs may ask whether they qualify for an exemption from the work requirements. DHHS will review information already available to determine whether a patient qualifies for a medical frailty exemption. If DHHS does not have enough information, the patient must submit an individual declaration form.
“It would be useful for providers to understand the process by which a patient could pursue a medical frailty exemption,” Joekel says. “There are going to be a lot of questions and a lot of concern around that for people with conditions that don’t allow them to work.”
Key takeaways for primary care teams
- Encourage Medicaid patients to update their mailing address, phone number, and other contact information with DHHS
- Remind patients to watch for and respond to DHHS notices, even if they believe they are still eligible
- Be aware that work requirements apply to some adults enrolled through Medicaid expansion, not all Medicaid patients
- Consider reviewing work requirement exemptions
- Know where to direct patients who may qualify for medical frailty or other exemptions
- Refer patients to DHHS resources for eligibility questions and next steps
Resources
- Nebraska DHHS work requirements
- Individual declaration form
- Medical frailty and SUD treatment program exemptions
- Nebraska DHHS Medicaid citizenship changes – Medicaid eligibility for noncitizens