The Nebraska Legislature's Health and Human Services Committee meeting on September 5, 2025, highlighted critical discussions surrounding the state's Medicaid program and its integrity measures. A significant focus was placed on the potential for "clawbacks," a financial recovery mechanism that some states have implemented due to budgetary concerns. Officials acknowledged the risks associated with Nebraska's current tax and budget situation, emphasizing the need for proactive measures to prevent similar issues seen in other states like Wisconsin and Indiana.

The committee discussed the importance of tightening program integrity and ensuring that Managed Care Organizations (MCOs) conduct thorough audits. The aim is to enhance oversight and maintain quality care for Medicaid recipients. Officials noted that while there have been no investigations by the Office of Inspector General (OIG) to date, they are committed to addressing any emerging issues before they escalate.

Another key topic was the oversight of Applied Behavior Analysis (ABA) clinics that accept Medicaid. The department is implementing stricter guidelines and service definitions to ensure quality care and appropriate utilization management. This includes setting thresholds for service hours and requiring documentation to justify continued care. The goal is to balance quality service delivery with access, ensuring that individuals receive necessary support without unnecessary barriers.

The committee also acknowledged the recent establishment of BCBA licensure infrastructure, which aims to enhance the qualifications of providers in the state. This move is part of a broader strategy to ensure that all Medicaid services meet high standards of care while remaining accessible to those in need.

As Nebraska navigates its budget challenges, the discussions from this meeting underscore the state's commitment to improving healthcare services and safeguarding the integrity of its Medicaid program. The proactive steps being taken aim to ensure that residents receive quality care while addressing financial sustainability in the face of potential clawbacks.