Vote Smart's Synopsis:

Vote on a motion to invoke cloture on a bill that expands Medicaid eligibility.

Highlights:

• Establishes the Wellness in Nebraska (WIN) Plan to provide health care coverage through a Medicaid expansion demonstration waiver to “newly eligible individuals”, through which they can purchase “qualified health insurance plans” with premiums paid by the Department of Health and Human Services (Sec. 34). 

• Defines “newly eligible individuals” as those individuals who meet the following criteria (Sec. 26):
• He or she meets the requirements of the Federal Social Security Act; 
• He or she is a resident of Nebraska; and
• He or she satisfies all applicable federal income, citizenship, and immigration requirements. 

• Requires the expansion of private health insurance plans to be pursuant to the medical assistance program for all newly eligible individuals with household incomes between 100 percent and 133 percent of the federal poverty line who are “medically frail” or have “exceptional medical conditions” (Sec. 5). 

• Defines “medically frail” and “exceptional medical conditions” as the following illnesses (Sec. 24):
• A disabling mental disorder;
• A serious and complex medical condition; and
• A physical or mental disabilities that significantly impair an individual’s ability to perform one or more activities of daily living.

• Authorizes the following individuals to be eligible for WIN Marketplace coverage (Sec. 37):
• Newly eligible individuals who do not have access to employer-sponsored insurance;
• Newly eligible individuals for whom employer-sponsored insurance is not determined to be cost effective by the Department; and
• Newly eligible individuals with household incomes between 100 percent and 133 percent of the federal poverty level, who are not determined to be medically frail or have exceptional medical conditions, as determined by the Department.

• Requires the Department to apply to the Centers for Medicare and Medicaid Services for any waivers or state plan amendments necessary to implement the WIN plan, beginning on January 1, 2015 (Sec. 36).

• Requires all newly eligible individuals enrolled in the WIN plan have access to a qualified, licensed primary care provider and enroll in a patient-centered medical home, where available, beginning on January 1, 2015  (Sec. 40).

• Authorizes the Medicaid wavier application to include a plan for a pilot program, for each managed care organization contracting with the Department, to develop at least three health homes for newly eligible individuals who are medically frail or have exceptional medical conditions (Sec. 41).

• Requires individuals enrolled in the WIN plan, with incomes at or about 50 percent of the federal poverty line, to contribute 2 percent of their monthly incomes towards the cost of insurance, beginning January 1, 2016 (Sec. 43).

• Specifies that individuals enrolled in the WIN plan are exempt from contributing 2 percent of their  incomes, beginning January 1, 2016,  if those individuals participate in certain wellness activities including, but not limited to, the following activities (Sec. 43): 
• Participation in yearly exams;
• Participation in screenings; and 
• Participation in immunizations. 

• Requires a copayment for the overutilization of a hospital emergency department to decrease the non-emergency use of an emergency department (Sec. 45).

• Establishes the Wellness in Nebraska Oversight Committee as a special legislative committee to oversee and monitor certain aspects of the WIN plan including the following aspects (Sec. 46):
• To review information from the Department;
• To participate with the Department in negotiations with the Centers for Medicare and Medicaid Services regarding Medicaid waiver applications; and
• To provide implementation recommendations to the Department.

Full Bill Text