Nebraska is channeling significant funds into deploying Medicaid coverage restrictions, setting aside millions for contractors to handle the implementation of new work requirements and eligibility checks. State documents, obtained by KFF Health News through a public records request, reveal that Nebraska’s health department has earmarked $8.2 million for these contractor costs.
Unlike many states that outsource their Medicaid eligibility systems, Nebraska maintains its own. However, it still leans on external companies to manage its Medicaid program. The $8.2 million expenditure, spanning two years, involves two main contractors: Boston-based Public Consulting Group and Atlanta’s Covendis, which provides IT staffing.
A senior consultant from Public Consulting Group praised Nebraska’s handling of the work requirements. “I really cannot brag enough about how well Nebraska handled this requirement,” said Latanya Michaux, highlighting the firm’s strong partnership with the state. Meanwhile, Covendis did not respond to requests for comment. Powell, a health department official, noted that contracted staff are used when hiring state employees is not feasible due to economic or time constraints, or when specialized skills are needed.
Advocates for Medicaid recipients in Nebraska have expressed concerns over confusion among enrollees about the applicability of the new rules. There have been reports of recipients receiving incorrect information. In December, Governor Pillen stated that no additional workforce would be added to implement work requirements, a decision criticized by advocates. Additionally, Pillen initiated a statewide hiring freeze in July.
Documents show that Nebraska named at least six contractors with costs exceeding $250,000 each, including one individual whose compensation tops $1.8 million. These records were submitted to federal Medicaid regulators to secure federal funding, although Powell indicated that these requests might not match actual spending.
Sarah Maresh from Nebraska Appleseed, a nonprofit advocacy group, described the financial figures as “shocking.” She noted, “When you put in complicated policies like this, there are large corporations making money behind the scenes.”
Confusion and Longer Wait Times
The Medicaid work requirements, part of the One Big Beautiful Bill Act, along with other Republican-driven changes, are expected to reverse insurance gains achieved through the Affordable Care Act. The law introduces new reporting requirements and restrictions that complicate enrollment. Internal documents obtained by KFF Health News indicate that most denials related to work requirements were due to unsubmitted paperwork, which the state anticipated.
Average wait times at Nebraska’s health department call center nearly doubled from May to July, increasing from 13 to 26 minutes before slightly improving in August. Over 101,000 calls were received in August, a 66% rise since May. Advocates report lengthy waits, with some individuals spending hours on the phone.
Kenny McMorris, CEO of Charles Drew Health Center in North Omaha, noted, “If people are working, they just don’t have time to be sitting on the phone to go through all of this stuff.” He reported that about half of the center’s 13,385 patients are on Medicaid, with 42% subject to work requirements.
The official data may not capture individual experiences, such as McCreary’s, who struggled to understand his Medicaid benefits amid a health crisis. McCreary, eligible for Medicaid due to the ACA, was unclear about the work requirements’ applicability. He expressed frustration, saying, “This cancer ain’t going to stop just because I ain’t got insurance.”
McCreary recounted his ordeal, where he mistakenly called a SNAP assistance line instead of the AccessNebraska call center. Despite attempts to clarify his situation, confusion remained. Prior to his health issues, McCreary worked as a driver, a job he had to leave due to his deteriorating health. He lamented, “I really had hoped to work longer. I kind of enjoyed that job.”
Legal and policy experts believe McCreary’s health conditions should have exempted him from work requirements. Nebraska’s health department communicated the new requirements through various channels, but McCreary, who prefers phone interactions, may have missed these notices.
Reflecting on his situation, McCreary said, “I don’t know if it’s my fault or not.”
