The Nebraska ballot on November 6, 2018 will include an issue asking voters to decide whether the eligibility guidelines for Medicaid should be expanded.
Approval would mean that Nebraskans with income up to 138% of the Federal Poverty Level would be eligible to receive their health insurance benefits through the Medicaid program. Medicaid benefits are administered at the state level, but funded jointly through Federal and State dollars.
Under current Nebraska guidelines, pregnant women can receive Medicaid benefits if their income is 194% or less of poverty level. Children can receive Medicaid benefits if the family income is 213% or less of poverty. Parents can receive Medicaid only when the family income is 63% or less of poverty. That figure could rise to 138% if the measure is approved and allow lower income adults without children to also qualify for Medicaid benefits.
Currently, eligibility guidelines for Medicaid in Nebraska:
- Parents with minor children with income up to 63% of poverty. Family of 4 = $15,800 or less.
- Pregnant women with income up to 194% of poverty. Single women = $23,500 or less.
- Children with income up to 213% of poverty. Family of 4 = $53,400 or less.
Medicaid expansion was incorporated into the Patient Protection and Affordable Care Act that was passed in 2010. The original version of the law required states to expand their Medicaid programs. That portion of the law was found unconstitutional. Subsequently, it was left to each state to determine whether to expand. To date, 33 states and the District of Columbia have already expanded their Medicaid programs, while 17 states have not.
The issue is deciding whether to ask the state to step in and provide health care for lower income individuals versus the cost of adding this to the state’s budget and the concept of expanding governmental authority.
Currently, those with income between 100% and 138% of the Federal Poverty Level will qualify for health insurance through healthcare.gov at a very low premium and reduction in out-of-pocket expenses. However, those with access to an employer-provided plan are typically not eligible for healthcare.gov. They can add family members to the employer’s group insurance, but most employers do not pay a large share of the premium for family members. They can get caught in the gap of not having any access to “affordable” health insurance.
If expansion is approved, the state will have the task of creating the program and the budget to fund it. Funding could potentially come from increased state revenues, be redirected from other budgeted items, or through additional taxes. This process would occur during 2019 with an anticipated effective date of 1/1/2020.
There have been efforts in the Nebraska Legislature in past years to approve Medicaid expansion. Those were not successful and have led to the issue now being presented through a ballot initiative. The democratic process is on display in the age-old debate of benefit vs. cost vs. government. We will be watching the election results.