PREPARED BY: Mikayla Findlay
LB 22 DATE PREPARED: January 21, 2025
PHONE: 402-471-0062
Revision: 00
FISCAL NOTE
LEGISLATIVE FISCAL ANALYST ESTIMATE
ESTIMATE OF FISCAL IMPACT – STATE AGENCIES (See narrative for political subdivision estimates)
FY 2025-26 FY 2026-27
EXPENDITURES REVENUE EXPENDITURES REVENUE
GENERAL FUNDS
CASH FUNDS
FEDERAL FUNDS
OTHER FUNDS
TOTAL FUNDS See below See below
Any Fiscal Notes received from state agencies and political subdivisions are attached following the Legislative Fiscal Analyst Estimate.
This bill requires the Department of Health and Human Services (DHHS) to submit a State Plan Amendment (SPA) for the Medicaid
program by October 1, 2025 to implement targeted case management (TCM) for evidence- based nurse home visiting services. The bill
indicates that these services are for families who have children younger than three years of age who are enrolled in the Children’s
Health Insurance Program (CHIP). The bill also states legislative intent to fund these services with cash funds from the Medicaid
Managed Care Excess Profit Fund. Due to availability of Federal Medical Assistance Percentage (FMAP) for Medicaid, it is assumed
that the cash fund s would make up the state’s matching requirement and not be the exclusive fund source of this initiative. Note that
revenue to the Medicaid Managed Care Excess Profit Fund is not guaranteed and lack of funding may result in fai lure to execute the
provisions of the program.
Currently, the only program in Nebraska that offer s nurse home-visiting is based out of the Lincoln- Lancaster County Public Health
Department . Due to increased funding for home -visiting provided by the legislature, Douglas County is starting a similar program. If the
SPA is approved, additional programs may launch state-wide.
DHHS notes that current Medicaid regulations do not define evi dence-based nurse home visiting. In seeking a SPA approval from
CMS, the Centers for Medicare & Medicaid Services, the definitions would be explicated for TCM for a specific patient population which
may be considered similar to populations that are exempt from coverage. This may extend the approval process. DHHS assumes
implementation by 1/1/2026 noting the possibility of later implementation depending on approval.
Though this bill exclusively references CHIP , the Medicaid and CHIP programs provide identical services for the child population. The
programs funding sources differ but from the recipient side the programs are seamless meaning if a family’s income results in
movement of the child or children between CHIP and Medi caid the services stay the same. DHHS indicates that in FY24 there were
approx. 400,000 member months for individual children under the age of three. The agency uses a utilization assumption of 25% and
assumed monthly rate of $100 to cal culate a total aid cost of $10 million. Assuming implementation of 1/1/2026, the aid cost in FY26
would represent half a fiscal year. The agency uses a blended FMAP of 57.20% for FY26 and 56.15% for SFY27. The blended FMAP is
based on the proportion of regular Medicaid member months and CHIP member months. This estimate appears to be reasonable at full
program implementation. As noted above there is only one pro gram fully operating and implementation of new programs statewide
would take significant time to develop therefore the actual cost in the initial years of the program should be less.
DHHS indicates potential administrative expenses upwards of $103,000 ann ually for a program manager depending on which division
the program will fall within the D epartment. Current home visitation operates with in the Division of Public Health however this bill would
involve Medicaid and Long-Term Care. DHHS also notes that ef forts to start the home-visiting program in Omaha may be duplicated
under this bill.
ADMINISTRATIVE SERVICES STATE BUDGET DIVISION: REVIEW OF AGENCY & POLT. SUB. RESPONSE
LB: 22 AM: AGENCY/POLT. SUB: Nebraska Dept of Health & Human Services
REVIEWED BY: Ann Linneman DATE: 1 -21-2025 PHONE: (402) 471-4180
COMMENTS: Concur with the Nebraska Department of Health & Human Services assessment of fiscal impact.
Technical Note: The amount of funding into the MCO Excess Profit Fund is unknown, so General Funds would be needed if
there is not adequate funding available.
LB (1) 22 FISCAL NOTE 2025
ESTIMATE PROVIDED BY STATE AGENCY OR POLITICAL SUBDIVISION
State Agency or Political Subdivision Name:(2) Department of Health and Human Services
Prepared by: (3) John Meals Date Prepared 1-17-2025 Phone: (5) 471-6719
FY 2025-2026 FY 2026-2027
EXPENDITURES REVENUE EXPENDITURES REVENUE
GENERAL FUNDS
CASH FUNDS $2,139,845 $4,385,383
FEDERAL FUNDS $2,860,155 $5,614,617
OTHER FUNDS
TOTAL FUNDS $5,000,000 $0 $10,000,000 $0
Return by date specified or 72 hours prior to public hearing, whichever is earlier.
Explanation of Estimate:
LB22 requires Medicaid to submit a state plan amendment (SPA) to the Centers for Medicare & Medicaid
Services (CMS) for targeted case management (TCM) for evidence- based nurse home visiting services
available to all postpartum mothers and children less than three years of age enrolled in Medicaid or Children’s
Health Insurance Program (CHIP). LB22 requires the non-federal share portion of the service be paid with the
Managed Care Excess Profit Fund. The usage of the Managed Care Excess Profit Fund for the non- federal
share portion is not a sustainable source of funding; this could lead to needing other funding sources, such as
General Funds, in the future.
Current Medicaid regulations do not define evidence- based nurse home visiting. There are other programs
and funding streams that provide targeted case management or nurse visits for postpartum mothers and
children less than three years of age. The SPA will require CMS approval to limit the TCM service to a specific
patient population that may be considered similar to patient populations exempt from the coverage. This will
require special review by CMS, possibly a waiver, and the date of October 1, 2025, might not be met. This
fiscal note assumes an implementation date of January 1, 2026. The expenses related to the effort and time
needed for the SPA and potentially a waiver, as well as other operational costs to implement this new
coverage, would be absorbed by the Department.
In state fiscal year 2024, there were approximately 400,000 unique member months for children under three
years of age. Assuming a utilization rate of 25%, this fiscal note assumes 100,000 member months are to be
covered at an estimated monthly rate of $100. The resulting annual increase in aid expenditures is $5 ,000,000
for SFY26 ($2,860,155 Federal Funds and $2 ,139,845 Cash Funds) and $10,00 0,000 for SFY27 ($5 ,614,617
Federal Funds and $4 ,385,383 Cash Funds). The blended FMAP for SFY26 used is 57.20% and for SFY27 is
56.15%. The blended FMAP was based on the proportion of regular Medicaid member months and CHIP
member months.
The Division of Public Health (DPH) currently oversees an evidence- based home visiting model that is not
nurse- based called the Maternal Infant Early Childhood Home Visitation (MIECHV) program. DPH does not
oversee any programs that would be considered “targeted case management”. DPH is currently in the process
of implementing a local evidence- based nurse home visitation project, called Family Connects, which is
localized in Omaha. If the services provided in LB22 are also provided through DPH’s existing home visiting
program, then there would be a substantial impact to the Department. The existing home visiting program
operates on a cost reimbursement basis through subawards to local implementing agencies. It is unclear
whether the Department is intended to implement the program itself or if LB22 is meant to designate where the
state share of costs associated with the SPA will be borne. If the Department is responsible for expanding the
existing Omaha pilot project statewide, new full-time associates might be needed, including at minimum a
program manager position with annual costs of $103,000.
An expansion of a statewide nurse home visitation program for Medicaid and CHIP recipients may allow DPH’s
existing home visiting program to reprioritize existing aid resources. The nurse home visiting program pilot that
is being launched in Omaha would appear to be redundant if LB22 were to pass and be implemented as-is. If
LB22 eliminated the need for the Omaha nurse home visiting pilot project, there would be a reduction in
$500,000 in costs per year against the Medicaid Managed Care Excess Profit Fund.
MAJOR OBJECTS OF EXPENDITURE
PERSONAL SERVICES:
NUMBER OF POSITIONS 2025-2026 2026-2027
POSITION TITLE 26-26 26-27 EXPENDITURES EXPENDITURES
Benefits...............................................................................................................................
Operating............................................................................................................................
Travel..................................................................................................................................
Capital Outlay.....................................................................................................................
Aid......................................................................................................................................
$5,000,000 $10,000,000
Capital Improvements.........................................................................................................
TOTAL............................................................................................................
$5,000,000 $10,000,000