Heritage Health Adult Expansion Program

Last update: October 6, 2020

Nebraska Medicaid and Long-Term Care (MLTC) has expanded Medicaid coverage. This means that more individuals than ever will be eligible for low-cost health coverage. Effective Oct. 1, 2020, Medicaid coverage will include adults, ages 19-64, whose annual income is less than 138% of the federal poverty level. DHHS estimates that 90,000 Nebraskans will be newly eligible through this Medicaid expansion. The new program, “Heritage Health Adult” (HHA), builds on the existing Heritage Health program for current Medicaid beneficiaries.

Heritage Health Adult expansion members will be enrolled in managed care plans through the existing Heritage Health program. Unlike existing Medicaid-eligible individuals, Heritage Health Adult members will receive either the “Basic” or “Prime” benefit package.

• The Basic benefit package includes comprehensive medical, behavioral health and prescription drug coverage.
• The Prime benefit package includes the Basic benefit package plus vision, dental and over-the-counter medications.

Heritage Health Adult members will receive the Prime benefit package if they are:

• Medically frail
• Age 19 or 20
• Pregnant

The provider may be asked to attest to their patient’s “medically frail” status, which will include the relevant diagnosis. The attestation form will be made available to the patient and will also be available at dhhs.ne.gov/pages/Medically-Frail.aspx. The attestation form can be submitted by the provider to DHHS:

• Through ACCESSNebraska
• By email: dhhs.medfrailreview@nebraska.gov
• By mail:

Attn: Heritage Health Adult Medically Frail Determinations

PO Box 95026

Lincoln, NE 68509

For more information about the Heritage Health Adult program, visit dhhs.ne.gov/Pages/Medicaid-Expansion.aspx.