Unpacking the Unwind: A Medicaid Listening Tour

In April and May 2023, Nebraska Medicaid held a series of listening sessions to gather feedback from providers, members, and advocates about challenges and opportunities as we begin the post-pandemic return to regular eligibility operations.

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Hearing from stakeholders during these sessions helps our program to remain transparent and accountable to those we serve. It helps us better understand where we can improve our service to Nebraskans. The ultimate goal of these sessions is to increase our understanding so we can continue delivering excellent care to Medicaid members throughout the state.

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"Unpacking the Unwind: A Medicaid Listening Tour" took place at eight locations across the state allowing members, providers, and community representatives to address their concerns directly with Nebraska Medicaid representatives. Two virtual sessions were also held.

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“We had a lot of excellent conversations with everyone who attended our listening tour,” Medicaid Director, Dr. Kevin Bagley said. “There is a lot going on with the unwind and we want to be sure the public understands what is happening.?At the same time, it is important that we hear their concerns and address them.”

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Over these ten listening sessions, two key themes emerged: barriers to accessing care and members’ difficulty navigating the healthcare system.

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Statewide Access to Care

During our listening tour, we heard from dentists, OBGYNs, assisted living facility staff, and others about ongoing difficulties in accessing care throughout Nebraska.?

Dental Care

Members of the dental community who attended our listening sessions highlighted the issue of rates for dentists and oral surgeons across the state.?Rates are subject to legislative appropriations.

Representatives of the community emphasized the lack of dental care available across the state, hindering members from receiving necessary treatment. Nebraska Medicaid is actively collaborating with the state’s dental community to address the reasons why some dentists do not enroll with Nebraska Medicaid.

In January, managed care contracts will be revised to improve the reimbursement and credentialing process for hygienists, dentists, and oral surgeons. Policy changes will also eliminate the dental benefit maximum for Nebraska Medicaid members, which currently restricts adult dental services to $750 per year.

Furthermore, reimbursement for dentures will be modified to ensure dentists are compensated at each step of the process, and coverage will be extended to include asymptomatic wisdom tooth extraction. These enhancements are expected to attract more dentists and oral surgeons, ensuring that patients can receive the care they need and deserve.

Maternal Care

Multiple representatives and medical professionals expressed their concern about the growing maternity deserts in western Nebraska and the challenges our rural members face.?We also heard about the need for consistency across our health plans regarding utilization management policies for ultrasounds, antepartum visits, and other necessary care for expecting mothers.?Providers also identified difficulties their offices face during the reimbursement process for 599 CHIP cases.

Nebraska Medicaid is actively working alongside our health plans to decrease the administrative burden on providers.?We are also planning to hold additional discussions with stakeholders to better understand how we can increase access to maternal care across the state.?We anticipate these changes and additional discussions will lead to improvements in the quality of maternal care for our members.

Assisted Living Facility Care

Throughout the listening tour, assisted living facility staff shared their concerns with Nebraska Medicaid regarding the ongoing closures of facilities in western Nebraska. Key issues included staffing challenges, logistical and administrative burdens imposed by federal regulations, and low reimbursement rates. We continue to explore what more might be done to help this situation.

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Difficulties Navigating Medicaid

Mothers of children with disabilities, community health workers, and advocates from across the state attended the listening sessions to provide insights into key areas of the program that could be improved to make the healthcare system more accessible for Medicaid members.

ACCESSNebraska

Providers and community health workers emphasized the need for improvements to the ACCESSNebraska website. They explained that the user interface is challenging to navigate, even for experienced users.

While the coming deployment of iServe presents an opportunity to improve members’ experience in managing their benefits, it is important that we acknowledge that the current systems present real constraints at this time on our ability to improve the customer experience. Nebraska Medicaid hopes to address these concerns in future system updates.

Notices

Community health workers and advocates also stressed that there is still significant work Nebraska Medicaid needs to do to improve our notices.

Our team has recently identified an opportunity to improve the language in our notices while working with community representatives to ensure that the notices are accessible to our members. Recognizing our technology systems are older and this makes it quite difficult to improve things quickly, nonetheless, we are working to make improvements to our notices over time.

Building Trust in Nebraska Medicaid

Several parents of children with disabilities attended Omaha’s listening session to share their stories of difficulty navigating our systems to access care for their children.?They expressed a sense of frustration with processes and policies that ultimately eroded their trust in our program.

It is important for our team to hear these stories and commit to improving our system so members can access the care they need. It is crucial that we build relationships of trust with stakeholders throughout the state.?Our members, providers, and other stakeholders should expect transparency and accountability from our program.?As we take the time to hear and understand the stories of our stakeholders across the state, we can make the improvements needed to foster additional transparency, accountability, and trust in our programs.

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Follow-up Actions for Nebraska Medicaid

Based on some of the input we received during the listening tour, Nebraska Medicaid is taking additional steps to respond to commonly asked questions we receive from members and representatives throughout the state.

Opportunities to Collaborate on the Unwind

A wide range of providers, advocates, assisters, and other community organizations explained their willingness to collaborate with Nebraska Medicaid to help with the post-pandemic return to regular eligibility operations.?We greatly appreciate their openness to collaboration in helping Medicaid members in understanding this process.

We made informational resources available to stakeholders to ensure that they have the tools needed to answer members’ questions.?In cases where stakeholders need messaging tailored to their communities, we are working to customize our messaging to fit their needs.?We will continue to have conversations with stakeholders to better understand where we can be proactive in renewing Medicaid members’ coverage.

Developing a Share of Cost Resources

Several parents of children with disabilities attended Omaha’s listening session to share their stories of difficulty navigating our systems to access care for their children.?They expressed a sense of frustration with processes and policies that ultimately eroded their trust in our program.

It is important for our team to hear these stories and commit to improving our system so members can access the care they need. It is crucial that we build relationships of trust with stakeholders throughout the state.?Our members, providers, and other stakeholders should expect transparency and accountability from our program.?As we take the time to hear and understand the stories of our stakeholders across the state, we can make the improvements needed to foster additional transparency, accountability, and trust in our programs.