PREPARED BY: Mikayla Findlay
LB 22 DATE PREPARED: February 25, 2025
PHONE: 402-471-0062
Revision: 02
Revised to account for varying federal participation rates 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 $352,521 $716,511
FEDERAL FUNDS $723,079 $1,434,689
OTHER FUNDS
TOTAL FUNDS $1,075,600 $2,151,200
Any Fiscal Notes received from state agencies and political subdivisions are attached following the Legislative Fiscal Analyst Estimate.
As amended, 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
for families who have children younger than six months of age who are enrolled in Medicaid. The bill 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 f unds 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 failure to execute the provis ions of the program.
DHHS notes that current Medicaid regulations do not define evidence-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 January 1, 2026 noting the possibility of later implementation depending on approval.
DHHS indicates that in FY24 there were approx. 86,048 member months for individual children under the age of six months. The
agency uses a utilization assumption of 25% and assumed monthly rate of $100 to calculate a total aid cost of $2,151,200. Assuming
implementation of January 1, 2026, the aid cost in FY26 would represent half a fiscal year. This fiscal note assu mes a blended FMAP of
67.23% for FY26 and 66.69% for SFY27. This blended FMAP assumes half of Medicaid home visiting will be for clients who are
covered at the regular FMAP (55.15% in SFY26 and 54.36% in SFY27), a quarter CHIP (68.6% in SFY26 and 68.05% in SFY27 ), and a
quarter Medicaid Expansion (90%). Only services billed to the parent would qualify for the Ex pansion federal participation as infants
only qualify for either regular Medicaid or CHIP. Actual aid expenditures depend on utilization of the program.
DHHS indicates potential administrative expenses upwards of $103,000 annually for a program manager depending on which division
the program will fall within the Department. Should the provisions of this bill warrant additional personnel the agenc y may request
additional admin funds via the budget process.
ADMINISTRATIVE SERVICES STATE BUDGET DIVISION: REVIEW OF AGENCY & POL T. SUB. RESPONSE
LB: 22 AM: 102 AGENCY/POLT. SUB: Nebraska Dept of Health & Human Services
REVIEWED BY: Ann Linneman DATE: 2 -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 AM102 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 2-21-25 Phone: (5) 471-6719
FY 2025-2026 FY 2026-2027
EXPENDITURES REVENUE EXPENDITURES REVENUE
GENERAL FUNDS
CASH FUNDS $473,909 $973,203
FEDERAL FUNDS $601,691 $1,177,997
OTHER FUNDS
TOTAL FUNDS $1,075,600 $0 $2,151,200 $0
Return by date specified or 72 hours prior to public hearing, whichever is earlier.
Explanation of Estimate:
LB22 AM102 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 up to six months of age enrolled in Medicaid. The bill
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
younger than six months old. 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 86,048 unique Medicaid member months for children under six months of
age. Assuming a utilization rate of 25%, this fiscal note assumes 21,512 member months are to be covered at
an estimated monthly rate of $100. The resulting annual increase in aid expenditures is $1,075,600 for SFY26
($601,691 Federal Funds and $473,909 Cash Funds) and $2 ,151,200 for SFY27 ($1,177 ,997 Federal Funds
and $973, 203 Cash Funds). The FMAP used for regular Medicaid expenses for SFY26 is 55.94% and for
SFY27 is 54 .76%.
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 AM102 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 AM102 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 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 overlapping if LB22 AM102 were to pass and be implemented as-is. If
LB22 AM102 eliminated the need for portions of the Omaha nurse home visiting pilot project, there could be a
reduction up to $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......................................................................................................................................
$1,075,600 $2,151,200
Capital Improvements.........................................................................................................
TOTAL............................................................................................................
$1,075,600 $2,151,200