I have received many questions this week regarding LB1087 (The Hospital Quality Assurance and Access Assessment Act), which I introduced in 2024. Although I have gotten the credit for passing this bill by the Governor and the Nebraska Hospital Association (NHA), I always remind people that it takes 25 votes to pass any bill, and there are countless hours spent behind the scenes developing the language to pass any comprehensive bill. This federal program has been in place for many years, but it has never had good traction in the Nebraska Legislature. First, the hospitals needed to all agree to collectively support the bill, since they are all required to contribute a portion of their net Medicaid revenues. These revenues are then matched 2.19 times by the federal government once the state program is approved by the Center for Medicare and Medicaid Services (CMS). The second obstacle was getting past prior hesitations from Governors and Legislatures to accept more federal funds.

The NHA came to me late in the summer of 2023 to ask me to carry the bill. They knew that I served on the Great Plains Health Board and had a good understanding of healthcare. They also felt that I could better explain the bill on the floor and get it through the process. By accessing these funds, we take pressure off the state to fund additional Medicaid provider rates. Some of the 41 states already using this program are using it to totally fund their Medicaid needs. In our case, we project receiving up to $1 billion in federal funding to augment the hospitals’ contributions. The state would also keep up to $150 million in fees from these proceeds.

Passing the bill meant getting the Governor, the hospitals, and the Legislature on board to support the bill. After discussions with the Governor, he was solidly in support. The NHA rallied its members, and 31 Senators agreed to co-sponsor the bill, with Senator Armendariz agreeing to designate the bill as her personal priority. In the end, the bill passed 45-0-1.

Following the passage, the state submitted a State Plan Amendment outlining implementation and waited for approval by CMS. That plan was developed and submitted to CMS last year prior to the election, but due to changes in the agency after the election, the process virtually stopped prior to the appointment and confirmation of a new HHS Secretary. We were very fortunate to get final approval just prior to passage of the Big Beautiful Bill, so we were grandfathered into the program. I want to thank Congressman Mike Flood for his work in making this happen. Also, the steadfast commitment of Governor Pillen to supporting the bill from beginning to end!

The first round of payments was made to Nebraska hospitals in late August. Several rural hospitals will remain open because of this bill. I am glad I could play a role in getting it done.

This year, I was asked by the Nebraska Medical Association (NMA) to introduce LB527 (Medicaid Assess and Quality Act). This bill is similar to LB1087, but increases federal Medicaid funding for doctors and non-hospital and non-behavioral health providers. The program matches Managed Care Organization (MCO) health insurance premiums that are paid into the program. This involves fewer dollars but brings federal funds to Nebraska to better compensate providers for providing medical services to Medicaid recipients.

Access to affordable healthcare, whether primary care providers, hospitals, or specialty services, must be a priority for Nebraska, particularly if we want to attract and retain residents in rural Nebraska.

It has been a pleasure serving as your State Senator. I enjoy the challenge and will continue to do my best to serve the interests of District 42. Please continue to reach out to me about issues that are important to you at 402-471-2729 or by emailing me at mjacobson@leg.ne.gov.