DHHS announced today that they will not receive approval from CMS for the Heritage Health Adult Phase II implementation plan in time to begin the demonstration on April 1, 2021. The Heritage Health Adult (HHA) Demonstration program would allow nearly 35,000 Nebraskans with Medicaid coverage through Medicaid expansion to access additional health care benefits by participating in wellness and personal responsibility activities. While DHHS has been preparing for the Phase II implementation for months, the Department will be required to pause this plan until it receives final approval from the federal government to begin the demonstration.
The state’s implementation plan was submitted to CMS for approval in December 2020. To this date, the state has yet to receive approval for this implementation plan. Based on a letter from CMS on February 12, 2021 and follow-up discussions with federal partners, it is unlikely the implementation plan will be approved in time to begin the program on April 1 as originally planned. Nebraska received initial approval from CMS to implement the program in October 2020.
The HHA Demonstration program is designed to promote the health and wellness of those who will participate in the program. Most people with coverage through Medicaid expansion will be eligible to participate. By choosing to complete the Wellness Initiatives and Personal Responsibility Activities that are part of the Demonstration program, members may qualify for additional benefits, including dental, vision, and over-the-counter drug coverage. Those who choose not to complete these activities will remain eligible to keep their current benefits.
The Wellness Initiatives include attending an annual health visit and completing a health risk screening. These initiatives help ensure that participants are more likely to get the care they need before a medical condition worsens and consequently helps ensure that the Medicaid program is not incurring preventable costs by providing the appropriate care in less costly settings.
“We are disappointed that CMS has chosen to delay the demonstration project, which would bring enhanced benefits for eligible Nebraskans,” said Kevin Bagley, director of the Division of Medicaid & Long-Term Care. “The department will continue to work with our federal partners to seek approval of the implementation plan so that we can help more Nebraskans take control of their personal health and live better lives.”
DHHS has provided CMS all of the information necessary to approve the launch of the HHA Demonstration program this year. Until this approval is confirmed, most Nebraskans with coverage through Medicaid expansion will continue to receive the basic Medicaid plan, and will be unable to access dental, vision, and over-the-counter drug coverage that are a part of the HHA Demonstration program which is awaiting federal approval.