Health and Human Services Committee
July 29, 2025
Committee Chair: Sen. Brian Hardin | Bills Heard: 1 | Full Transcript (PDF)
1115 Waiver Amendment: Substance Use Disorder Services Demonstration Waiver Amendment
Introduced by: Sen. Department of Health and Human Services (Drew Gonshorowski, Director of Division of Medicaid and Long-Term Care) | Testimony: 0 proponents, 0 opponents, 0 neutral | Read bill text (PDF)
Nebraska Medicaid seeks federal approval to expand mental health and homeless services under substance use disorder waiver. The Department of Health and Human Services presented an amendment to its existing 1115 Demonstration Waiver that would authorize two new services: short-term psychiatric hospital stays (up to 60 days) for individuals in crisis and medical respite care for homeless populations post-discharge.
Why it matters: The waiver targets a documented gap in coverage. The existing SUD waiver has served over 6,000 people in the past five years who wouldn't have qualified for Medicaid coverage otherwise. Respite facilities—costing roughly $250 per day versus $2,000 for hospital care—are expected to reduce costly emergency room readmissions and improve outcomes for vulnerable populations.
What they're saying: - Director Gonshorowski: The waiver must maintain budget neutrality and won't impact the state budget. Individuals with substance use disorder or serious mental illness would be excluded from new federal work requirements under HR 1. - Sen. Fredrickson: Pressed on long-term sustainability amid federal budget neutrality requirements and state budget pressures, asking how continuity of care will be maintained. - Sen. Riepe: Highlighted the cost savings and noted the Nebraska Hospital Association Foundation's financial commitment to the respite facilities.
By the numbers: Year one projections show approximately 100 members per month receiving SMI/SED services; year two jumps to roughly 1,024 member months. The Omaha facility is identified as Siena Francis House; Lincoln location still being identified.
What's next: This is a public comment hearing required by Nebraska law. The department plans to submit the waiver to CMS after the comment period closes, with anticipated effective dates of January 1, 2026 for psychiatric stays and April 1, 2026 for respite services. No vote was taken; this was an informational hearing.
Committee sentiment: Supportive: Sen. John Fredrickson, Sen. Dan Quick, Sen. Merv Riepe, Sen. Beau Ballard Unclear: Sen. Brian Hardin
Sentiment estimated from questions and comments — not stated positions.
Session Notes
This was a required public hearing under Nebraska Revised Statute Section 81-604 for a federal 1115 Demonstration Waiver amendment. The hearing was held during the public comment period before submission to CMS. No proponents, opponents, or neutral testifiers appeared beyond the department presentation. Committee Chair Hardin noted this was a smaller demonstration waiver based on Senator Riepe's LB905 from 2024. The department indicated it is awaiting formal federal guidance on implementation of HR 1 provisions, particularly regarding work requirements and co-pay requirements for Medicaid expansion populations.
Generated by NE Wire Service | Source: Nebraska Legislature Transcribers Office This is an AI-generated summary. Verify all claims against the official transcript.