From start to finish, the Center sees Medicaid expansion through

Rural Health

By Trenton Buhr, former staff member

This October marks the culmination of two and a half years of hard work by advocates, partners, and the Center for Rural Affairs to expand Medicaid in Nebraska. In summer 2018, we started by asking Nebraskans to sign the ballot initiative. Now, implementation has finally arrived.

For the communities we work in across Nebraska, this has been an issue which frequently hits home. There are 90,000 or more Nebraskans who are living in the coverage gap, meaning they make too much to qualify for traditional Medicaid and too little for marketplace subsidies. Medicaid expansion is designed to cover this group, making between 100 and 138 percent of the federal poverty level.

A larger share of that population lives in rural Nebraska, which often leaves rural hospitals and clinics feeling the effects of lack of coverage. Although the Affordable Care Act was passed 10 years ago, this group of Nebraskans has still been living without access to health insurance because state officials chose not to expand Medicaid when given the option starting in 2012.

In 2018, the Center sprung into action. We helped gather some of the more than 100,000 signatures that placed expansion onto the November 2018 ballot. After a successful push, Initiative 427 passed, setting in motion the process toward implementation. Now, with implementation on the horizon, rural Nebraskans, as well as small town hospitals and clinics, stand to benefit from expanded access to care, helping keep our rural health care infrastructure intact.

Last spring, Gov. Pete Ricketts announced that the Nebraska Department of Health and Human Services (DHHS) would be seeking to alter the Medicaid program for the expansion population. The plan includes two tiers of benefits—basic and prime. Dental, vision, and over-the-counter medication are only available in the prime package. To receive those benefits, enrollees will need to meet a number of requirements.

Sadly, new enrollees will not have access to prime benefits when expansion begins Oct. 1. Due to the COVID-19 pandemic, the Centers for Medicare and Medicaid Services was unable to approve Nebraska’s Medicaid expansion plan in time.

With the delay, DHHS has decided that until the plan is approved, only the basic benefits package will be available. Those who are 19 to 20 years old, pregnant, or medically frail will still receive prime benefits. We don’t know exactly when the program will be approved, but expect it to occur next spring.

Nebraska will be the 36th state to implement Medicaid expansion come October. Recently, two more states, Oklahoma and Missouri, expanded through a ballot initiative. Six of the 38 expanded states have now used this process. Time and again, we see Americans opting for the benefits of expanded health coverage.

If you, a friend, or family member are currently in the coverage gap, you can enroll anytime through DHHS. Applications are available online at or at your local DHHS office. For any questions, contact the Medicaid assistance line at 855.632.7633.

Our work isn’t finished yet. Let’s make sure that everyone who needs coverage gets it.