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LINCOLN, Neb. — Seven months after Nebraska voters approved expanding Medicaid, some 90,000 residents who could qualify for the health care program are still waiting.

According to Republican Gov. Pete Ricketts’ administration, they’ll be waiting for another 15 months.

Officials in the administration say they’re working to ensure the smooth implementation of the expansion, which voters passed despite the governor’s objections.

Skeptics note that Republicans have long objected to expanding Medicaid under the federal health care law championed by then-President Barack Obama, a Democrat. Medicaid, which provides health coverage for lower-income and disabled Americans, is funded jointly by states and the federal government. The 2010 Patient Protection and Affordable Care Act encouraged states to expand Medicaid by promising that the federal government would cover most of the cost.

Nebraska was among several conservative states that declined to expand Medicaid, as first Gov. Dave Heineman and then Ricketts argued it would cost too much and overwhelm the health care system.

It was one of three states with Republican-controlled legislatures where voters last year approved an expansion. In Utah, lawmakers subsequently cut nearly in half the number of people who would be covered and added spending caps and work requirements. Idaho lawmakers also imposed work requirements and other restrictions.

In Nebraska, the Legislature did not pass any changes to the voter-approved measure. But Ricketts’ administration decided to implement a two-tiered program: a “basic” plan available to all newly qualified recipients, and a “premium” plan available to people who are working, in school, volunteering or caring for a relative.

State Sen. John McCollister, a Republican from Omaha, said the Nebraska Department of Health and Human Services created a needlessly complex system that he believes runs contrary to the will of voters. McCollister said a straightforward expansion likely would have been easier and allowed people to get coverage sooner.

Advocates have noted that similar expansions took less than six months in Louisiana and Virginia and less than two months in Alaska. Expansion took longer in Maine, primarily because of opposition from elected officials.

Nebraska Department of Health and Human Services officials have defended the October 2020 launch date and their two-tiered approach, calling the expansion plan an enormous undertaking that shouldn’t be rushed. They note some changes still need federal approval.

The state also needs to upgrade its computer system for processing applicants, hire more workers and negotiate new contracts with the private, managed-care companies that will serve Medicaid recipients, officials said. They also say the state needs more doctors who accept Medicaid patients.

Coverage would be available to adults ages 19 to 64 who earn up to 138% of the federal poverty level — about $16,753 per year. The federal government must pay 90% of the program’s cost in 2020 and subsequent years.

The Nebraska Hospital Association, which supported the ballot measure, has accepted the state’s timeline.

However, Jordan Rasmussen, policy manager for the Nebraska-based Center for Rural Affairs, noted that the state is losing out on millions in federal funding while setting up the program.

“The delay is hurting Nebraska,” she said. “We’re missing out, and our people aren’t getting the care they need.”

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