Nebraska bill to expand prenatal Medicaid reimbursements advanced to full Legislature
LINCOLN — A Nebraska bill to expand Medicaid reimbursements for prenatal care to include nutrition counseling and targeted case management has advanced to the floor of the Legislature.
Legislative Bill 857, introduced by State Sen. George Dungan of Lincoln, would adopt the Nebraska Prenatal Plus Program, similar to ones in Florida and Colorado. Under Dungan’s bill, reimbursement could begin at about six months prior to birth.
The Health and Human Services Committee adopted an amendment intended to tighten up definitions and significantly reduce a sizable fiscal note attached to the bill. LB 857 would apply to at-risk mothers who are Medicaid recipients but not mothers in the Children’s Health Insurance Program. It would also reduce reimbursements to prenatal care, not postpartum care.
In addition, the amendment clarifies targeted case management as a sort of “air traffic controller,” working directly with expecting mothers, and sets a maximum reimbursement of six nutrition counseling visits.
“They may seem small, but to the moms who actually take advantage of those programs, they will be huge and they will have a massive impact both on their health and the health of their baby,” Dungan said.
The Prenatal Plus Program would be funded through the state’s Medicaid Managed Care Excess Profit Fund, instead of the state General Fund.
Addressing health disparities
Dr. Ann Anderson Berry, medical director of the Nebraska Perinatal Quality Improvement Collaborative, testified at the bill’s Wednesday hearing on behalf of her organization and the Nebraska Medical Association that adverse neonatal outcomes — such as preterm births before 37 weeks gestation — are increasing in frequency.
In Nebraska, she said, the minority infant mortality rate is three to four times higher than white infants.
“This is an unacceptable public health outcome,” Anderson Berry told the Health and Human Services Committee.
Chad Abresch, senior adviser for CityMatCH that works to promote and improve the health of urban women, families and communities, said he’s worked with Prenatal Plus programs nationwide for over a decade, including in Florida and Colorado.
He said similar programs have had success in reducing such health disparities as Anderson Berry identified, such as in Palm Beach County, Florida, where Black babies were dying at a rate nearly four times as often as white babies. After the state adopted Prenatal Plus, the disparity dropped by more than half.
Abresch said that for each 1,000 Nebraska women who may enroll in the program, at least two more two more “would be buying cake and singing ‘Happy Birthday’ in a year’s time rather than saying goodbye much too soon.”
“Two lives saved every year, senators,” Abresch said. “That’s a profound possibility.”
Dungan received support from various organizations Wednesday, including Nebraska Appleseed, the ACLU of Nebraska, Nebraska Right to Life and the Nebraska Catholic Conference. More organizations submitted letters in support, including:
- Nebraska State Board of Health.
- Nebraska Hospital Association.
- Nebraska Child Health & Education Alliance (the letter lists 10 member organizations).
- Health Center Association of Nebraska.
- Nebraska Nurses Association.
State Sen. Ben Hansen of Blair, HHS Committee chair, told Dungan that it may be the “most kumbaya bill” of 2024 so far through the testifiers.
‘Healthy moms, healthy babies’
The Nebraska Department of Health and Human Services submitted a neutral letter addressing how Dungan’s amendment might lower an initial fiscal impact of $7.4 million in the first year followed by $14.7 million in the second, which is a “ceiling” of what it could cost.
Dungan told the committee he estimates his amendment could reduce the cost to between $1.3 million and $1.8 million. He said in a text the cost may be just over $1 million upon further math.
Sara Howard, a former state senator and policy adviser at First Five Nebraska, which helped write LB 857, said Colorado’s Prenatal Plus Program led to significant Medicaid cost savings, also justifying the cost, though she said just the availability is important.
A 2002 Colorado state report states that for every dollar spent on Prenatal Plus, it equated to a $2.48 return on investment.
“One thing I think we can all agree about is we need healthy moms and healthy babies,” Dungan told the committee.
The committee voted 5-0 on Thursday to advance LB 857. The vote remained open to allow two absent committee members — State Sens. Lynne Walz of Fremont and Brian Hardin of Gering — to weigh in later. Walz said in a text she supports the measure.