Medicaid Benefit Plans
Heritage Health is the name of the healthcare delivery system for Nebraska’s Medicaid clients. It combines three areas of health care into one system. Those three areas are:
- Physical health - doctor and hospital visits related to your body’s well-being
- Behavioral health - doctor and hospital visits related to your mind’s well-being
- Pharmacy programs - prescription drugs/medicine ordered by your doctor
There are three different Heritage Health programs. It is important to know which program you have. If you are not sure please call Member Services. We will help you. The phone number is 1-844-385-2192, Nebraska Relay Service 711.
This is the traditional Medicaid Managed Care program. Nebraska Total Care has served this population since 2017.
Heritage Health Adult (HHA)
This benefit began on October 1, 2020. It is often called “Medicaid Expansion”. The requirements to qualify for HHA are different from Heritage Health.
There are two benefit groups for HHA.
Heritage Health Adult- Basic
- Over-the-counter medications
Heritage Health Adult- Prime
- 19-20 years old
- Medically frail. This means you have specific medical conditions.
HHA Medically Frail
Medically frail means that a person has complicated health needs. Nebraska Department of Health and Human Services (DHHS) has a process for assessing members. They decide who is medically frail. There are guidelines they follow. You can tell DHHS if you may be medically frail. Or, you can tell us.
The categories for medically frail are
- Disabling mental disorder (including serious mental illness)
- Chronic substance abuse disorder
- Physical, intellectual, or developmental disability with functional impairment that prevents the beneficiary from performing one (1) or more activities of daily living for each occurrence of the activity
- Disability determination based on Social Security criteria
- Serious and complex medical condition(s)
- Chronically homeless defined by the United States Department of Housing and Urban Development
If you may be medically frail we can help you with the assessment. We can:
- Talk to you about your health and circumstance.
- Talk to your providers
- Help you get the documents you need
- Help send your information to DHHS. If we send information to DHHS we will send you a letter to tell you.
If you want help with the process please call Member Services. The phone number is 1-844-385-2192, Nebraska Relay Service 711. If we think you may be medically frail we will contact you. DHHS will send you a letter with their decision.