Health care proposals will top Nebraska lawmakers’ spending in 2024

LINCOLN — Spending for health care proposals will top the charts for spending in 2024 as Nebraska lawmakers round the corner of the 2024 legislative session this week.

With just one day left in the 60-day session, a review of spending and revenues — excluding biennial budget adjustments also passed this year — shows lawmakers set aside $755 million in state funds either from Nebraska’s main pocketbook or various cash funds and reserves. The state could receive about $1.5 billion in federal funds, most for health care programs.

This comes out to $2.2 billion in state and federal spending, over 95% of which is allocated toward health care programs, while raising $672 million in state funds.

Proposals ranged from tapping into a larger federal pool of funds for Medicaid support for hospitals and partnering with an Iowa-based nonprofit for prescription drug donations to exempting National Guard income from state income taxation.

Lawmakers will consider eight final proposals when they convene this Thursday — seven of which relate to taxes or revenues. Preliminary final estimates for these bills would equate to more than $15 million in expenses and $160 million in reduced revenues to the state, such as lowering taxes.

Here is a review of some of the state’s spending plans so far, many of which were sent to Gov. Jim Pillen’s desk last Thursday after a voting spree that included 32 fiscal requests.

Hospitals and nursing facilities

The largest proposal passed and already signed into law is North Platte State Sen. Mike Jacobson’s Legislative Bill 1087, the Hospital Quality Assurance and Access Assessment Act, which calls to create a fee on Nebraska hospitals based on their quarterly net patient revenue that would, in turn, unlock federal funds that most states already have access to.

With a total price tag of more than $2 billion — of which more than $1.4 billion is federal funds — the bill sets aside $650 million, expected to be matched in revenues for a net-zero cost.

A fiscal note estimates that hospital assessments would yield $581 million in the first year, but the additional fiscal authority is if actual assessments come in above projections.

The Nebraska Department of Health and Human Services will need to submit a state plan amendment to the Centers for Medicare and Medicaid Services for approval to impose an assessment on hospitals.

The second costliest proposal is LB 130, from State Sen. Myron Dorn of Adams, which increases a quality assurance assessment imposed on licensed nursing facilities. Rather than $3.50 for each resident day, minus Medicare days, the quarterly assessment would be $9 for each resident day.

Nursing facilities receive payments back in enhancements to the daily Medicaid resident rate.

Dorn’s proposal, which Pillen approved last week, would cost $20 million but is also estimated to have a net-zero cost with matching revenue. It could draw $28 million in federal funds.

Opioid treatment and prevention

LB 1355, from State Sen. Tony Vargas of Omaha, would appropriate $3 million to be dispersed to six statewide regional behavioral health authorities for opioid treatment and response, data tracking and support. 

An additional $9 million would go into a fund for local and state public-private partnerships for opioid use prevention and opioid treatment infrastructure projects. 

The bill has a total cost of $13.5 million.

LB 1320, from State Sen. Beau Ballard of Lincoln, was also included in Vargas’ bill. It would require any emergency medical service provider who treats or transports a person experiencing a suspected or actual overdose to report the incident within 72 hours when possible. 

The information could not be used for criminal investigation but would be sent to the Washington/Baltimore High Intensity Drug Trafficking Area Overdose Mapping and Application Program, or a similar program.

Other health care proposals

Among other health-related programs passed this spring with a cost:

• LB 857, from State Sens. George Dungan and Carolyn Bosn, both of Lincoln, would create the Nebraska Prenatal Plus Program and expand coverage of continuous glucose monitors for at-risk mothers. The provisions have an approximate $6.7 million cost, divided between $2.5 million in state funds and $4.2 million in federal funds.
• LB 358, from State Sen. Lynne Walz of Fremont, would increase dental services reimbursements provided by Medicaid. Nebraska DHHS estimated it could absorb an estimated $3.4 million cost of the bill alongside $6.6 million in federal funds.
• LB 204, from State Sen. Merv Riepe of Ralston, seeks to reimburse pharmacy dispensing fees under Medicaid. DHHS also estimated it could absorb an estimated state cost of $2.5 million alongside $4.5 million in federal funds.
• LB 1035, from State Sen. Jana Hughes of Seward, would create the Prescription Drug Donation Program Act to partner with Iowa’s SafeNetRx to allow certain prescription drugs to be returned to pharmacies in Nebraska for distribution to low-income patients. It would be the first partnership for statewide distribution outside Iowa.
• LB 829, from State Sen. Carol Blood of Bellevue, would prohibit insurance policies from imposing a deductible co-insurance or cost-sharing requirement for removing polyps or for biopsies associated with a screening for colorectal cancer for people 45 and older. The proposal would start Jan. 1, 2025, with an annual estimated cost of $104,090.

National Guard and prison reform

Beyond health care proposals, lawmakers also approved bills meant to incentivize recruits for the Nebraska National Guard, improve career readiness and decrease recidivism for Nebraska inmates and raise funds by increasing the state fee on commercial corn sales.

LB 52, from State Sen. Loren Lippincott of Central City, would increase the cap of state tuition assistance for Guard members from $900,000 to $1 million. 

LB 1394, from State Sen. Tom Brewer of north-central Nebraska, would further exempt National Guard income from state taxation beginning Jan. 1, 2025. This year’s proposal would completely exempt all income for part-time Guard members other than their being called up for active duty, such as weekend drill pay and two-week annual training pay.

An estimate for LB 1394 states it would annually reduce state revenues by about $2 million.

LB 631, from State Sen. Terrell McKinney of Omaha, would enact a series of reforms to the state’s Board of Parole and state prisons, including expanding work to create work release and reentry centers throughout the state.

The bill also includes provisions from Bosn to create a pilot educational certificate program for justice-involved individuals. The goal is to improve employability and job skills.

The proposal has an estimated cost of $2.2 million in its first year.