Is Nebraska Total Care Medicaid


Longtime Local Physican Leaving Post As Mlh Chief Medical Officer

What We do Matters. Fuel your Career at Nebraska Total Care.

HASTINGS Dr. Michael Skoch announced today his resignation as Chief Medical Officer at Mary Lanning Healthcare, effective in March 31. He is leaving to become Chief Medical Director of Nebraska Total Care, headquartered in Omaha.

Leaving Hastings will be more than bittersweet, Dr. Skoch said. My family and I have been greatly blessed by relationships we have shared, both personal and professional. As we look with anticipation to the future, we will carry fond memories of and a profound sense of gratitude for our time in Hastings.

Dr. Skoch founded the Moscati Health Center in 2000. Prior to that, he was a physician at the Physicians Building Family Practice, now known as Family Medical Center, in Hastings. He was appointed MLH Chief Medical Officer in 2012. He worked in the MLH Emergency Department, and developed the Hospitalist Service during his tenure as Chief Medical Officer at MLH.

We are grateful to Dr. Skoch for his many years of commitment to the Hastings community, said Eric Barber, Mary Lanning Healthcare President & CEO. Please join me in thanking Dr. Skoch for the countless contributions he has made to the success of MLH and for the lives he has touched. He is a dedicated physician who has given much of his time and talent to the medical staff and Hastings. He will truly be missed.

Past Efforts To Expand Coverage Via Legislation Were Unsuccessful

In 2013, LB577, which would have created a modified Medicaid expansion program, was rejected by the legislature in Nebraska. A year later, the Wellness in Nebraska Act was introduced in January 2014 by Senator Kathy Campbell, but it didnt pass during the 2014 legislative session, and was indefinitely postponed in April 2014.

The Wellness in Nebraska Act would have expanded traditional Medicaid to people with incomes up to the poverty level , and would have relied on federal Medicaid funding to purchase private coverage for people with incomes between 100% and 138% of poverty. Several states are using waivers to implement unique approaches to Medicaid expansion, and New Hampshire and Arkansas both use waivers purchasing private coverage for at least some Medicaid enrollees.

In 2015, lawmakers introduced Legislative Bill 472 to expand Medicaid, but it did not pass out of committee. Also in 2015, two professors from the University of Nebraska-Kearney that found that expanding Medicaid would result in significant financial benefits for the state. After exhaustive study, the researchers concluded that expansion of Medicaid passes a rigorous cost/benefit analysis.

In January 2016, Nebraska State Senator John McCollister , introduced Legislative Bill 1032 in an effort to expand Medicaid in Nebraska. McCollister had been leading the push for Medicaid expansion in the state for almost a year at that point, but his legislation failed to advance out of committee.

Introducing Nebraska Total Care

Established to deliver quality healthcare in the state of Nebraska through local, regional and community-based resources, Nebraska Total Care is a Managed Care Organization and subsidiary of Centene Corporation . Nebraska Total Care exists to improve the health of its beneficiaries through focused, compassionate and coordinated care. Our approach is based on the core belief that quality healthcare is best delivered locally.

How to Reach UsIf you are a Heritage Health member and have questions about Nebraska Total Care, you can reach Member Services at 1-844-385-2192 . We have people to help you Monday-Friday, 7 a.m. to 8 p.m., Central.

If you are a Nebraska Total Care member we can send you printed copies of anything you need within 5 days at no cost. Please call Member Services.

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Ambetter From Nebraska Total Careyour Partner For Success

Ambetter from Nebraska Total Care is Centene Corporations Health Insurance Marketplace product. Ambetter exists to improve the health of its beneficiaries through focused, compassionate and coordinated care. Our approach is based on the core belief that quality healthcare is best delivered locally.

Coordinated System Has Three Managed Care Organizations

Nebraska Total Care

As of 2013, nearly 76% of Nebraskas Medicaid enrollees were in managed care programs run by Aetna, AmeriHealth, and UnitedHealthcare. The state overhauled its Medicaid managed care system in 2016, and managed care contract bids were submitted by six carriers in early January.

The overhauled program is called Heritage Health, and it combines coverage of physical health, behavioral health, and pharmacy care into one coordinated system. The new system took effect January 1, 2017. Three carriers were awarded contracts to serve as managed care plans under Heritage Health:

  • Nebraska Total Care
  • UnitedHealthcare Community Plan
  • Wellcare of Nebraska

These three carriers will also serve the new Heritage Health Adult population once Medicaid expansion takes effect in late 2020.

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Unitedhealthcare Connected Benefit Disclaimer

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.

You can get this document for free in other formats, such as large print, braille, or audio. Call , TTY 711, 8 a.m. – 8 p.m., local time, Monday – Friday . The call is free.

You can call Member Services and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.

Language Line is available for all in-network providers.

Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al , TTY 711, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.

Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro.

Los servicios Language Line están disponibles para todos los proveedores dentro de la red.

Aown Your Place For Meals At Home

Total Care Management – Medicaid Waiver

Medicare Options / Senior Care Options

The Aging Office of Western Nebraska is committed to helping older Nebraskans find the right care at the

right time. For individuals who are considering admission to a nursing home, community based services

may be an option so they may continue to stay at home. Medicaid allows for persons who are aged 65

and older and meet certain eligibility criteria to have the choice of entering the facility or receiving

assistance in the home or another alternative to the nursing home. This assistance should not be confused

with Medicare benefits.

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What Is Heritage Health

Heritage Health is a new healthcare delivery system that combines Nebraskas current physical health, behavioral health, and pharmacy programs into a single comprehensive and coordinated system for Nebraskas Medicaid and CHIP clients.

For Heritage Health enrollment information, please call 1-888-255-2605, or visit the Heritage Health website.

Nebraska Total Care offers the services you and your family want and need. Our services include:

  • Primary Care Visits
  • Wellness and Healthy Rewards Programs
  • Prescriptions
  • Care and Disease Management Services
  • Behavioral Health and Substance Use Services and Programs
  • Hearing and Vision Services

Requesting An Appeal With Your Health Plan:

Nebraska Total Care supports NAMIWalks
  • Contact a member representative from your health plan by phone or mail
  • The member handbook from your health plan tells you how to file an appeal
  • You have sixty days from the date on your notice of adverse benefit determination to request an appeal with your health plan
  • Your health plan must continue your benefits if you request to continue benefits and file your appeal with the health plan on time. The services also have to have been ordered by an authorized provider and your authorization period must not have run out.
  • You may represent yourself at this hearing or be represented by another person

More information is available in the member handbooks for your plan at the following links:

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Apply For Medicaid In Nebraska

You can enroll online at or use the call center at 1-800-318-2596. You can also enroll online at ACCESSNebraska, or print a paper application from their website.

Eligibility: Parents with dependent children are eligible with household income up to 57% of poverty. Pregnant women with income up to 194% of poverty, and children with income up to 213% of poverty.

The Specifics Of Nebraskas Medicaid Expansion 1115 Waiver Approved By Cms In October 2020

Although lawmakers in Utah and Idaho passed legislation in 2019 to adjust the terms of the Medicaid expansion ballot initiatives that voters had passed in those states, Nebraska lawmakers did not . Instead, the Nebraska-specific modifications to Medicaid expansion have come from Governor Ricketts administration. And while the modifications are not as draconian as those implemented in other states , Nebraska is still deviating from the version of Medicaid expansion called for in the ACA and approved by the states voters and is adding administrative cost and additional complexity.

To expand Medicaid, Nebraska has added the Heritage Health Adult Program to its existing Heritage Health Program. Initially, the state had planned to transition about 25,000 low-income parents and caretaker relatives who are already eligible for Medicaid in Nebraska to the Heritage Health Adult Program for these enrollees, rather than the enhanced matching rate that applies to the newly-eligible population). But the draft 1115 waiver proposal that the state published in October 2019 noted that the Heritage Health Adult Program would only include people who are newly eligible for Medicaid under the expansion guidelines .

Starting in year two , enrollees will also have to fulfill a work requirement in order to qualify for Prime Coverage. For 80 hours each month, they will need to either be working , going to school, volunteering for a public charity, or serving as a caregiver for a relative.

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Why Nebraska Total Care

At Nebraska Total Care, we understand how important you and your family’s healthcare needs are. It’s important to us too. We are here to support your health needs and make that part of your day easier. Nebraska Total Care is your partner and advocate.

How to Reach UsIf you are a Medicaid member and have questions about Nebraska Total Care, you can reach Member Services at 1-844-385-2192 .

Unitedhealthcare Connected For Mycare Ohio

Medicaid Managed Care Spending in 2017

UnitedHealthcare Connected® for MyCare Ohio is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. If you have any problem reading or understanding this or any other UnitedHealthcare Connected® for MyCare Ohio information, please contact our Member Services at from 7 a.m. to 8 p.m. Monday through Friday for help at no cost to you.

Si tiene problemas para leer o comprender esta o cualquier otra documentación de UnitedHealthcare Connected® de MyCare Ohio , comuníquese con nuestro Departamento de Servicio al Cliente para obtener información adicional sin costo para usted al de lunes a viernes de 7 a.m. a 8 p.m. .

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How Do I Enroll For Medicaid In Nebraska

You can submit an application for Medicaid any time during the year. Applications can be made online or by phone.

If you are under 65 and dont have Medicare:

  • You can enroll online at at any time Medicaid enrollment is available year-round. You can also enroll by phone via the call center at 800-318-2596.
  • You can also enroll online at ACCESSNebraska at any time.
  • The Do I Qualify screening tool at ACCESSNebraska can help you determine which public programs youre eligible for: You may be able to enroll in other benefits beyond Medicaid.

If youre 65 or older or have Medicare:

How Do I Report Waste Abuse Or Fraud

To report Medicaid fraud, contact the Nebraska Medicaid Fraud Hotline toll-free at 1-800-727-6432, or send an email to . You may also call MCNA Dentals Fraud Hotline toll-free at 1-855-392-6262.

To complete a Medicaid Fraud and Patient Abuse Complaint Form online, please go to . On the home page, click on the blue button that says Medicaid Fraud. Next, click on File Medicaid/Patient Abuse Complaint. You can choose to fill out and submit the Medicaid Fraud and Patient Abuse Complaint Form online or download a copy to print and mail.

You can find more information about Waste, Abuse, and Fraud in your Member Handbook.

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How Does Medicaid Provide Financial Assistance To Medicare Beneficiaries In Nebraska

Many Medicare beneficiaries receive Medicaid financial assistance that can help them with Medicare premiums, lower prescription drug costs, and pay for expenses not covered by Medicare including long-term care.

Our guide to financial assistance for Medicare enrollees in Nebraska includes overviews of these programs, including Medicaid long-term care benefits, Extra Help, and eligibility guidelines for assistance.

Who Is Eligible For Medicaid In Nebraska

Transforming the Health of the Community

Nebraskas Medicaid eligibility guidelines changed in August 2020, although coverage for newly-eligible adults wont begin until October 2020. Coverage is available for the following populations:

  • Adults through age 64 with income up to 138% of the poverty level .
  • Pregnant women with household income up to 199% of poverty.
  • Children with household income up to 218% of poverty

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American Disabilities Act Notice

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 , UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

Unitedhealthcare Dual Complete Plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call TTY 711 for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

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Enroll As A Member Of Mcna Dental

If you live in Nebraska, you or your children may qualify for Medicaid dental care! To see if you are eligible and get help with enrollment, call the Medicaid Customer Service Center at:

  • Toll-Free: 1-855-632-7633
  • Lincoln: 1-402-473-7000
  • Omaha: 1-402-595-1178

The Department of Health and Human Services administers and manages eligibility for the Nebraska Medicaid Program. Learn about eligibility and much more on the ACCESSNebraska website. You can access it from any computer, at any time.

Please call our Nebraska Member Hotline at 1-844-351-6262 if you have any questions.

Nebraska Medicaid Enrollment Numbers

Medicaid Home and Community

By mid-April 2014, 9,879 Nebraska exchange applicants had enrolled in Medicaid or CHIP. They were already eligible based on the pre-2014 enrollment guidelines, but may not have known that Medicaid was available to them.

But from the fall of 2013 through July 2016, total net enrollment in Nebraskas Medicaid program actually by 9,764 people, which amounted to a decrease of 4%. , however, enrollment was back to nearly where it had been in 2013, with only 188 fewer enrollees.

The state estimated that about 90,000 people would gain coverage under Medicaid expansion, although that number is likely to be higher now that the COVID-19 pandemic has resulted in widespread job losses. The pandemic had increased the number of people relying on Medicaid even before expansion took effect.

As of May 2021, 324,200 Nebraskans are enrolled in Medicaid/CHIP programs.

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Representing Singular Expertisethrough Exceptional Experience

Centene Corporation is a multinational Fortune 500 company with over 30 years of experience in the Managed Care industry and a robust portfolio of specialty health solutions. Ambetter plans are designed to deliver high quality, locally-based healthcare services to its members, with our providers benefiting from enhanced collaboration and strategic care coordination programs.

Can I Get My Member Materials In Another Language

Yes! You can get MCNAs member materials in English and Spanish. We also offer Braille and large-print versions for visually impaired members. This website is also available in paper form. There is no charge, and you will receive it within five business days. Contact our Member Hotline at 1-844-351-6262 to learn more.

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Requesting A State Fair Hearing:

  • You can request a State Fair Hearing after your appeal to the health plan has been finalized
  • You must send the appeal request for a State Fair Hearing in writing
  • Send your appeal request to:Department of Health and Human Services MLTC Appeal CoordinatorPO Box 94967Lincoln, NE 68509-4967
  • You have 120 days from the date on the notice of resolution for the health plan appeal to request a State Fair Hearing.
  • Once you have filed the appeal request for a State Fair Hearing, a hearing will be scheduled and you will be notified of the time and place
  • You may represent yourself at this hearing or be represented by another person

Provider Changes And Demographic Updates

Working Remotely, Member Care is Always Our Focus

There is an easy way for you to request updates to your information and ensure we receive what we need to complete your request in a timely manner. Simply .

As a Nebraska Total Care provider, you can rely on:

  • A comprehensive approach to care for your patients through disease management programs, healthy behavior incentives and 24-hour toll-free access to bi-lingual registered nurses
  • Initial and ongoing provider education through orientations, office visits, training and updates
  • A dedicated claims team to ensure prompt payment
  • Minimal referral requirements and limited prior authorizations
  • A dedicated provider relations team to keep you informed and maintain support in person or by phone
  • The ability to check member eligibility, authorization and claims status online
  • Healthcare collateral for your patients and educational displays for your office

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