Medicaid agency: DHHS / MLTC
Nebraska Medicaid is administered by the Department of Health and Human Services (DHHS), a five-division agency spanning Behavioral Health, Children and Family Services, Developmental Disabilities, Medicaid and Long-Term Care (MLTC), and Public Health; Nebraska has run comprehensive statewide risk-based managed care, Heritage Health, since January 1, 2017, integrating physical health, behavioral health, dental, and pharmacy under one program. The current three-MCO slate (Molina Healthcare of Nebraska, Nebraska Total Care, and UnitedHealthcare Community Plan of Nebraska) holds contracts running January 1, 2024 through December 31, 2028, with two optional one-year renewals; CHIP, branded Kids Connection, is delivered through the same three MCOs and the same Heritage Health structure rather than a separate program. Medicaid expansion, approved by voters as Initiative 427 in 2018, took effect October 1, 2020 as Heritage Health Adult, a two-tier Alternative Benefit Plan adding dental, vision, and over-the-counter medication benefits for expansion members that remains part of the program today. Nebraska became the first state in the nation to implement federal work requirements, effective May 1, 2026, eight months ahead of the federal January 1, 2027 deadline; the policy requires 80 hours per month of work, training, education, or volunteering, or at least $580 in monthly earnings, from expansion members ages 19-64, phased in through mid-2027 and estimated to affect roughly 72,000 Nebraskans.
CMS's most recent managed care enrollment data, report year 2024, shows Nebraska's Heritage Health program delivered through three comprehensive MCOs (Molina Healthcare of Nebraska, Nebraska Total Care, and UnitedHealthcare Community Plan of Nebraska) with a combined 350,237 members. A separate dental-only managed care organization, present in every report year through 2023, no longer appears in the 2024 data, consistent with dental's integration into the three MCOs' own contracts that year. A much smaller Program of All-Inclusive Care for the Elderly serves 214 members, most of them dual-eligible, across a set of Omaha-area zip codes.
Long-term services and supports run largely outside the three Heritage Health MCO contracts, delivered fee-for-service through five active Section 1915(c) home- and community-based waivers: Family Support (ages 0-21, autism and intellectual/developmental disabilities), Comprehensive Developmental Disabilities Services (all ages, same population), Developmental Disabilities Day Services for Adults (ages 21+), Aged, Adults, and Children with Disabilities (ages 65+, or ages 0-64 with physical disabilities, nursing facility level of care), and Traumatic Brain Injury (ages 18+, nursing facility level of care). A separate Section 1915(i) State Plan option, running concurrently with the Heritage Health 1915(b) waiver since January 1, 2025, adds targeted case management for adults with serious mental illness.
Not integrated into managed care
Behavioral health is capitated directly into the three Heritage Health MCOs rather than carved out to a separate vendor, unified with physical health, dental, and pharmacy inside the single current Heritage Health 1915(b) waiver.
Carved in
Dental coverage was integrated into the three Heritage Health MCOs' own contracts effective January 1, 2024. No MCO-specific dental subcontractor is named on Heritage Health's own materials.
Pharmacy benefits run through a split, multi-vendor structure rather than one statewide administrator. Prime Therapeutics administers the fee-for-service Pharmacy Point-of-Sale system, preferred drug list, and related clinical services; each Heritage Health MCO otherwise manages pharmacy through its own contracted PBM, UnitedHealthcare Community Plan of Nebraska through OptumRx and Nebraska Total Care through Express Scripts. Molina Healthcare of Nebraska's PBM arrangement is not named on its own materials.
Non-emergency medical transportation is subcontracted through each Heritage Health MCO rather than a single statewide broker. UnitedHealthcare Community Plan of Nebraska uses MTM, Inc., effective January 2026. Modivcare also operates as an active NEMT broker in Nebraska; which broker Nebraska Total Care and Molina Healthcare of Nebraska each use is not named on their own materials.
Nebraska operates its Medicaid Management Information System in-house, replacing it module by module rather than through a single vendor transition; Maximus operates the Provider Services module, and Automated Health Systems serves as Heritage Health's enrollment broker.
143 agency updates tracked for Nebraska. Available with Pro.
See them with ProNebraska, the first state to implement a Medicaid work reporting requirement, presented initial implementation data at a recent Medicaid Advisory Committee meeting. The data cover the first few months after the state began applying new work-reporting rules to new applicants, and show coverage losses attributed to administrative red tape rather than ineligibility. Beneficiaries affected include new Medicaid applicants subject to the reporting rules. The findings arrive as the work reporting requirement is set to become mandatory nationally, making Nebraska an early test case for how implementation affects enrollment.
Nebraska counties receiving opioid settlement payments are increasingly directing those dollars to regional behavioral health authorities rather than managing substance abuse programs independently, according to the report. These authorities are seen as better equipped to administer treatment and prevention services than individual county governments. The trend reflects how localities are distributing a multi-year stream of settlement funds from opioid litigation. No specific timeline or dollar figures for the shift were detailed in the report.
A policy brief examines Nebraska's process for verifying compliance with Medicaid work requirements and reports early data on how enrollees subject to the requirement have fared. The brief details how the state confirms work, education, or other qualifying activities, and what share of affected enrollees have successfully verified compliance versus those at risk of losing coverage. Findings are relevant as more states implement or plan similar requirements following federal changes expanding work requirement mandates. The brief highlights administrative and verification challenges that could inform other states' implementation strategies.
Nebraska has reduced Medicaid funding for nearly 900 people with developmental disabilities after implementing an algorithm-based eligibility determination system. The cuts affect individuals receiving long-term services and supports through the state's Medicaid program. Families report that the state is removing vital funding without clear explanation of how the algorithm calculates need or eligibility. The action raises questions about the use of automated systems in Medicaid eligibility and benefit determinations, particularly for vulnerable populations requiring intensive services.
Nebraska State Auditor Mike Foley released a 34-page report on August 24, 2026, alleging highly questionable billing practices and weak oversight in the state's Medicaid Aged and Disabled Waiver program. The program's costs increased nearly 600% over the past decade. The audit identifies specific billing irregularities and oversight deficiencies in waiver program administration. The findings raise compliance and fiscal integrity concerns for Nebraska's HCBS waiver operations and may prompt corrective action by the state Medicaid agency.
12 active waivers tracked for Nebraska. Available with Pro.
See them with ProNo active solicitations currently tracked for Nebraska.
6 managed care contracts tracked for Nebraska. Available with Pro.
See them with Pro47 bills tracked for Nebraska. Available with Pro.
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