Health and Human Services Committee
January 23, 2025
Committee Chair: Sen. Hardin | Bills Heard: 4 | Full Transcript (PDF)
LB22: Allow nurse home visiting programs to bill Medicaid
Introduced by: Sen. Dungan | Testimony: 11 proponents, 2 opponents, 1 neutral | Read bill text (PDF)
Medicaid expansion would fund nurse home visits for postpartum mothers and newborns. LB22 authorizes reimbursement for evidence-based nurse home visiting programs like Family Connects, which provides 3-4 visits to new mothers within weeks of hospital discharge. The bill would use targeted case management billing to tap federal Medicaid dollars.
Why it matters: Nebraska has seen success with Family Connects in Lincoln since 2023, with research showing a 408% return on investment and 73% reduction in infant hospital visits. Medicaid funding would allow expansion beyond Lincoln and Omaha to rural areas facing maternal health deserts. However, the state's Medicaid Excess Profit Fund—which would cover Nebraska's share—has limited resources and faces competing demands.
What they're saying: - Proponents: "For every dollar invested in Family Connects, we see $4.08 in savings," said Kerry Kernen, Lincoln-Lancaster County Health Department. The program is voluntary, evidence-based, and the federal government covers 90% of costs for postpartum mothers under Medicaid expansion. - Skeptics: Sen. Riepe worried about expanding Medicaid commitments when the Excess Profit Fund has only $45 million and faces multiple competing bills. He also noted benefits may concentrate in urban areas rather than rural Nebraska.
By the numbers: 925 postpartum visits completed in Lincoln since September 2023; 36% of mothers and 54% of children served are on Medicaid; Greene County, Missouri study projects $22.2 million in savings over 4 years.
What's next: No vote was taken. Sen. Dungan indicated openness to amendments narrowing the age range and clarifying the federal match rate, which could significantly reduce the fiscal note.
Committee sentiment: Supportive: Sen. Fredrickson Skeptical: Sen. Riepe Unclear: Sen. Ballard
Sentiment estimated from questions and comments — not stated positions.
LB41: Require additional syphilis screening during pregnancy
Introduced by: Sen. Riepe | Testimony: 17 proponents, 5 opponents, 1 neutral | Read bill text (PDF)
Nebraska would require three syphilis screenings during pregnancy to prevent congenital infections. LB41 updates a 1943 statute to align with current CDC guidelines, adding screenings in the third trimester and at delivery to the existing first-visit test. Syphilis is easily treated with penicillin but causes devastating outcomes if missed.
Why it matters: Nebraska has seen a staggering 1,100% increase in congenital syphilis cases since 2017. Babies born with untreated maternal syphilis face stillbirth, developmental delays, hearing and vision loss, and permanent brain damage. One neonatologist reported treating only one case in 20 years of practice but now regularly treats multiple infants requiring intensive care. The screening is simple and inexpensive; preventing just three NICU admissions annually would offset the entire $216,000 fiscal note.
What they're saying: - Proponents: "Since implementing three-point screening at our hospital, I have not needed to admit a single infant to the NICU for syphilis treatment," said Dr. Ann Anderson Berry, a neonatologist. The test is a simple finger prick or blood draw with results in 20 minutes. - Data: Douglas County saw congenital syphilis cases jump from 1 case (2013-18) to 16 cases (2019-24). Infectious syphilis among women in Douglas County is at 9.5 cases per 100,000, more than double the CDC's Healthy People 2030 goal of 4.6 per 100,000.
By the numbers: 373% increase in overall syphilis cases statewide since 2017; 1,163% increase among females; $216,000 fiscal note; average NICU stay costs $70,000-90,000.
What's next: No vote was taken. Committee appeared supportive. Sara Howard noted that managed care organizations are already billing for additional screenings, suggesting actual fiscal impact may be significantly lower than the fiscal note.
Committee sentiment: Supportive: Sen. Meyer, Sen. Hansen, Sen. Fredrickson
Sentiment estimated from questions and comments — not stated positions.
LB42: Allow certified nursing assistants to maintain licensure while working in developmental disability and home care settings
Introduced by: Sen. Riepe | Testimony: 4 proponents, 0 opponents, 0 neutral | Read bill text (PDF)
Bill would let nursing assistants keep licenses while working in home care and disability services. LB42 expands where certified nursing assistants can maintain active registry status to include intellectual and developmental disability providers and home and community-based service agencies. Currently, CNAs can only keep licenses active in hospitals, nursing homes, and assisted living—forcing workers in home care and disability fields to choose between their careers and their credentials.
Why it matters: Home care and disability services face severe workforce shortages. CNAs working in these fields often have clients with complex medical needs, but the current rule forces them to either let their licenses lapse or work part-time in nursing homes just to maintain certification. This drives turnover and makes recruitment nearly impossible. Home care is half the cost of institutional care and allows seniors to age in place, reducing burden on long-term care facilities.
What they're saying: - Proponents: "We have a large number of employees that are nurse aides that submit an application for their license to be renewed, and they are denied," said Andrew Carlson, CEO of Home Care Partners. "These nurse aides have to make a difficult decision. They can choose to lose their license that they worked hard for... or resign from their position." - Workforce impact: Hands of Heartland has 290 direct support professionals, about 30 of whom hold CNA licenses. The Arc of Nebraska called the workforce shortage "an absolute crisis" straining families.
By the numbers: Home care industry experiences 80%+ annual turnover; onboarding costs $3,000 per employee; home care costs roughly half of assisted living.
What's next: No vote was taken. Bill passed committee 7-0 last year but died on fiscal note. This year carries neutral fiscal note, removing previous barrier. Committee appeared unanimously supportive.
Committee sentiment: Supportive: Sen. Quick, Sen. Meyer, Sen. Hansen
Sentiment estimated from questions and comments — not stated positions.
LB71: Accelerate childcare subsidy reimbursement increases for Step Up to Quality participation
Introduced by: Sen. DeBoer | Testimony: 21 proponents, 1 opponents, 1 neutral | Read bill text (PDF)
Bill would reward childcare providers earlier for quality improvements. LB71 moves the 5% subsidy reimbursement increase from Step 3 to Step 2 of Nebraska's Step Up to Quality program. The change addresses a perverse incentive: providers currently spend more to reach Step 3 than they gain from the 5% increase, discouraging participation in quality improvement.
Why it matters: High-quality early childhood education builds cognitive, emotional, and social foundations that improve K-12 outcomes, graduation rates, college attendance, and lifetime earnings. Yet many providers are financially penalized for advancing their skills. Since 2020, Step Up to Quality participation grew 106%, but only 30% of enrolled programs reach Step 3 or higher—and that proportion is declining. Providers cite financial barriers, lack of coaching support (especially Spanish-speaking coaches), and the cost-benefit mismatch as reasons for stalling at Step 2.
What they're saying: - Proponents: "The most critical time for investment in quality is up front, to support a foundation on which to build that quality," said Lameakia Collier, Nebraska Early Childhood Collaborative. "Early investment yields higher returns." - Workforce: Higher reimbursement would help providers address rising operational costs, improve staff wages, and offset program improvement costs—all critical for workforce retention.
By the numbers: Step Up to Quality participation: 406 programs at Step 1, 368 at Step 2, 107 at Step 3, 35 at Step 4, 63 at Step 5. Only 736 family homes and 610 centers accept subsidy out of ~2,400 providers statewide. Only one Spanish-speaking coach available.
What's next: No vote was taken. Sen. DeBoer acknowledged high fiscal note and invited committee to find creative solutions. Committee appeared supportive of the bill's aims.
Committee sentiment: Supportive: Sen. Fredrickson, Sen. Hardin Unclear: Sen. Riepe
Sentiment estimated from questions and comments — not stated positions.
Session Notes
Committee Chair Hardin opened with procedural instructions regarding testifier sheets, sign-in sheets, 5-minute light system, and written position letter deadlines (8 a.m. day of hearing via Legislature website). Committee members present: Sen. Ballard (District 21), Sen. Quick (District 35), Sen. Fredrickson (District 20), Sen. Riepe (District 12). Legal counsel John Duggar and clerk Barb Dorn assisted. Pages: Sydney Cochran (UNL, business administration and U.S. history) and Tate Smith (UNL, political science). Josephine Litwinowicz testified as proponent on multiple bills (LB22, LB41, LB42, LB71), providing personal perspective on healthcare workforce and provider rate issues while also making political commentary. Sen. DeBoer was unable to close on LB71 due to other committee obligations. Online testimony counts: LB22 (11 proponents, 2 opponents, 1 neutral); LB41 (17 proponents, 5 opponents, 1 neutral); LB42 (4 proponents, 0 opponents, 0 neutral); LB71 (21 proponents, 1 opponent, 1 neutral). No votes were taken on any bills during this hearing.
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