From her post in the neonatal intensive care unit at Children\u2019s Nebraska, Dr. Ann Anderson-Berry sees some of Nebraska\u2019s sickest and smallest patients.<\/p>\n
It\u2019s a devastating and unexpected end to a pregnancy, where the baby\u2019s survival is often in question. For parents who rely on Medicaid, the government insurance program for low-income and disabled Americans, filling out the pages of paperwork to get their newborn covered is rarely top of mind.<\/p>\n
\u201cIt\u2019s just too tenuous to go home, or to think about paperwork,\u201d said Anderson-Berry, division chief of neonatology at Children\u2019s Nebraska. \u201cAnd so, sometimes these applications are not submitted in the first days or even the first couple of weeks after delivery.\u201d<\/p>\n
Those families \u2014 and other Medicaid-eligible patients seeking emergency care \u2014 have long had a grace period to apply, because by law, Medicaid would go back and retroactively pay for three months of care before the application. <\/p>\n
Nebraska\u2019s Department of Health and Human Services is now seeking to end that retroactive coverage altogether.<\/p>\n
If adopted, Nebraska would be the only state in the country to entirely eliminate retroactive coverage, including for children and pregnant women. Ten other states currently have reduced retroactive coverage, though they all have some exceptions for certain groups or allow a longer coverage period than what Nebraska has proposed, according to KFF\u2019s Medicaid Waiver Tracker<\/a>. DHHS is currently accepting public comment on the proposal.<\/p>\n State officials argue the move will save Nebraska millions of dollars each year, and it will incentivize hospitals to quickly enroll Medicaid-eligible patients.<\/p>\n But health care officials, advocates and some lawmakers say the move will do more harm than good, and that harm will fall on an already stressed health care system and on the state\u2019s most vulnerable residents \u2014 low-income Nebraskans needing urgent and costly care.<\/p>\n \u201cIt\u2019s cruel and it\u2019s a money grab in my opinion \u2026 it\u2019s placing an administrative burden to help save the state money at the expense of everybody else in the health system,\u201d said Justin Wolf, CEO of Memorial Community Health hospital in Aurora.<\/p>\n Medicaid enrollees in Nebraska would still be covered within the calendar month that they applied for care, but if a person experienced a medical emergency toward the end of February, for example, and wasn\u2019t able to submit the application until March 1, none of their care in February would be covered.<\/p>\n For patients in an emergency, those first days of care are often the most expensive. A NICU baby\u2019s regular care costs about $4,000 per day, Anderson-Berry said. A baby with extremely low birth weight can have hospital bills well over $1 million.<\/p>\n Eliminating retroactive coverage won\u2019t just impact Medicaid-eligible newborns and their families. Any low-income Nebraskan with an emergency \u2014 who gets in a bad car accident or has a heart attack \u2014 could be unable to finish their application by the last day of the month.<\/p>\n \u201cPlan your heart attack for the first week of the month,\u201d Anderson-Berry said. <\/p>\n Medicaid retroactive coverage is intended to prevent low-income people from going into severe and crippling medical debt, said Sarah Maresh, health care access program director at Nebraska Appleseed.<\/p>\n It also protects hospitals and providers by making sure they will be paid for care, Maresh said, especially in catastrophic situations like a traumatic car accident, where hospitals must provide care regardless of whether a patient has insurance.<\/p>\n Ending that retroactive coverage will create a financial incentive for hospitals to be \u201ctimely and thorough\u201d when helping patients complete Medicaid applications, because the majority of costs will be shifted to hospitals, DHHS Chief Financial Officer John Meals said at a legislative hearing in February.<\/p>\n But hospitals already spend a lot of money actively engaging with patients to help them enroll in Medicaid or private insurance, said Jeremy Nordquist, CEO of the Nebraska Hospital Association. Still, there\u2019s a portion of the population that hospitals can\u2019t reach until they\u2019re brought in as emergency patients.<\/p>\n \u201cWe do the best we can with folks who come in our door \u2026 putting this burden on hospitals to go out and constantly do Medicaid enrollment just doesn\u2019t work with the resources that hospitals have available,\u201d Nordquist said.<\/p>\n Nebraska DHHS officials declined to be interviewed for this story. A spokesman said DHHS leadership was busy with legislative and budget discussions. <\/p>\n Even without action by the state, the window for retroactive Medicaid coverage is already slated to narrow.<\/p>\n President Donald Trump\u2019s 2025 tax and spending bill, often called the \u201cOne Big Beautiful Bill,\u201d cut the existing three full months of retroactive coverage to one month for the Medicaid expansion population and two months for traditional Medicaid enrollees like children and disabled adults. The Medicaid changes take effect Jan. 1, 2027.<\/p>\n DHHS is applying for a five-year waiver that will go beyond the federal changes. Nebraska plans to set retroactive coverage to zero months, effective Oct. 1, Meals told lawmakers last month.<\/p>\n Unlike the federal changes, though, Nebraska\u2019s proposed cuts would be across the board.<\/p>\n \u201cThey\u2019re proposing to eliminate it for every Medicaid population, including people with disabilities, nursing home residents, pregnant folks, Medicaid babies and children,\u201d Maresh said.<\/p>\n Other states have already reduced retroactive eligibility, though they ultimately carved out exceptions.<\/p>\n In 2017, Iowa did something similar to what Nebraska is proposing and eliminated all retroactive coverage, except for pregnant women and infants. But the state eventually added more exemptions for children and long-term care residents after facing pushback from nursing homes because of the financial strain, Maresh said.<\/p>\n