Navigating stumbling blocks to Medicaid expansion

Rural Health

By Eric Galatas, Public News Service - Nebraska

Last year, Nebraska voters passed a measure to expand Medicaid, but state officials are stumbling out of the gate to implement the plan. 

The move would bridge a health-coverage gap for 94,000 Nebraskans who don't earn enough to get subsidies for market-rate insurance, but earn too much to qualify for standard Medicaid. Valerie Bower is a registered nurse at Mary Lanning Healthcare in Hastings. She said expanding Medicaid also is critical for keeping hospital doors open.

"Rural hospitals especially benefit from Medicaid expansion,” Bower said. “A lot of rural hospitals have been closing in the last few years, and a lot of that has to do with uncompensated care."

Bower's hospital has carried more than $9 million in bad debt, on top of providing $5 million in financial assistance for patients who just can't pay. Medicaid expansion would help reimburse hospitals for skilled care provided by nurses, doctors and technicians, as well as supplies and medication. 

Nebraska's Department of Health and Human Services has cited technology upgrades, staffing and reporting requirements as reasons for a possible delay in coverage.

Jordan Rasmussen, policy manager with the Center for Rural Affairs, said Medicaid expansion also would get Nebraska closer to a goal championed by many state lawmakers: strengthening the economy and bringing more economic opportunities into the state.

"There are strong economic benefits that will result because of our expanded coverage,” Rasmussen said. “A report that was shared last fall estimates that $1.3 billion in economic activity is going to occur in the state. That's a huge gain for the state."

Nebraska must submit its plan for Medicaid expansion to the Centers on Medicaid and Medicare by April 1 of this year. More than two-thirds of Nebraskans who fall into the Medicaid coverage gap are employed, and more than 1-in-3 live in rural counties.