Let your voice be heard by submitting a comment on Medicaid expansion

Judy Sandeen wasn’t planning on testifying when she walked into the Kearney Public Library last fall for the second of four public hearings on the implementation of Medicaid expansion in Nebraska.

But, as she signed in, the Hastings, Nebraska, resident, thought about her friend, Todd Ruhter.

“I thought ‘well, why not?’ because this was a huge thing that happened with Todd,” Judy said.

Todd had long fought for the Medicaid expansion, often traveling from Grand Island to Lincoln to speak with Nebraska lawmakers, despite being very ill.

As she listened to others testify and have “really important things to say,” Judy noticed they weren’t offering the personal stories she believed officials with the Nebraska Department of Health and Human Services (DHHS), the agency responsible for implementation of the program, needed to hear.

So, she began jotting down notes about the man who grew up on a ranch near Grand Island, with whom she struck up a friendship as they advocated for a number of issues, including those surrounding health care.

“I thought there needed to be a face, an individual, someone who lost his life because this (expansion) hadn’t happened,” Judy said.

Todd, who died in April 2015, was among Nebraskans who fell into the coverage gap when it came to health insurance—they earn more than Medicaid’s income threshold but not enough to qualify for subsidies from the insurance marketplace.

After years of debate, with 53 percent of voters approving, a ballot initiative to expand Medicaid was approved in November 2018. While passage came too late for Todd, Judy and other supporters were happy voters saw the need.

But, that happiness has abated as the state’s plan, unveiled early last year, included not what voters had thought would be a fall 2019 start date, rather a 2020 implementation. Also part of the plan was a complex waiver process which would tier benefits and make other changes to Medicaid.

“The whole foot-dragging is so frustrating,” Judy said. “There are still real people suffering because of the slow-walking that is happening.”

A health care professional for 56 years, Judy has seen the impact of the lack of insurance of all kinds, not just Medicaid.

“It’s just been heartbreaking to see people not have proper and appropriate care because they didn’t have the proper resources for it,” she said.

The next phase of the Medicaid expansion process includes a federal comment period. As Judy did, the Center for Rural Affairs encourages residents to let their voices be heard by submitting a comment. Comments can be submitted here until 11 p.m., Jan. 17.

The comment period comes as the result of an application submitted by the Nebraska DHHS, Division of Medicaid and Long Term Care, on Dec. 12.

In its application, DHHS officials submitted a section 1115(a) demonstration application proposing to implement a two-tiered benefit package for its new adult group. Despite opposition voiced by hundreds of Nebraskans during the hearings, only minor changes were made.

On Jan. 2, the Center submitted its own comments.

“Health care access and its radiating economic consequences has a direct impact upon the well-being of rural residents and communities,” said Jordan Rasmussen, policy manager. 

Rasmussen addressed the need to uphold the will of the voters, to make sure access to vision, dental and over-the-counter drug benefits remains and rural Nebraska’s stake in Medicaid expansion.

“While expansion does not offer the solution to all of the challenges of rural health care delivery, the expedient and unencumbered implementation of Medicaid expansion will make a difference for thousands of rural residents and the communities they call home,” Rasmussen wrote. “It is time to move forward with the will of voters and implement Medicaid expansion without barriers.”

Click here to read the full text of the Center’s letter.