Administrators in the Nebraska Department of Health and Human Services outlined the plan to a joint legislative committee but said it’s too early to know exactly how it will look when it goes live around October 2020.

One major uncertainty is the benefits that will be available to low-income residents who sign up for coverage. Some benefits, such as medical checkups and hospital visits, are mandatory under federal law for states participating in Medicaid.

But other benefits, including physical therapy, mental health treatment and hospice care, are considered optional. Nebraska’s plan isn’t likely to cover all 19 optional services, said Rocky Thompson, a deputy director for Nebraska’s Medicaid and Long-Term Care division.

“We haven’t made any decisions yet about the exact benefit package,” Thompson said.

The proposal unveiled last week creates a basic plan for all newly qualified recipients and a premium plan that’s only available to people who are working, in school, volunteering or caring for a relative. The premium plan would cover dental and vision appointments, as well as over-the-counter drugs.

Nebraska Medicaid and Long-Term Care Director Matthew Van Patton said the two plans were an effort to provide “an innovative route to wellness and life success” for Medicaid recipients. The department operates under the administration of Republican Gov. Pete Ricketts, who opposed efforts to expand Medicaid in the Legislature but promised to respect the wishes of voters who approved it in November .

“We care about treating the whole person and want them to live a full and productive life,” Van Patton said.

Some lawmakers who support the Affordable Care Act questioned the need for the extra requirements needed to get premium coverage.

Sen. Tony Vargas, whose south Omaha district is one of the biggest beneficiaries of Medicaid expansion, called the requirements “punitive” and voiced concern about patients bouncing back and forth between the different plans.

“I’m just worried we’re creating more hoops for people to walk through,” he said.

Sen. Anna Wishart of Lincoln questioned whether the wellness incentives would prove effective. She said she has participated in similar programs that worked well and others “that were a complete joke.”

Wishart said she was also concerned that officials were making the program needlessly complicated and possibly costing the state more because state employees will have to monitor recipients to ensure they’re meeting the requirements. Van Patton said the state workers who would check compliance will have to be hired anyway for other tasks.

The ballot measure requires the Department of Health and Human Services to submit a state Medicaid plan amendment to the federal government to cover an estimated 90,000 newly eligible, low-income residents.

Once it’s in place, coverage will become available to adults ages 19 to 64 who earn up to 138 percent of the federal poverty level — about $16,753 per year. The federal government is required to pay 90 percent of the program’s cost in 2020 and subsequent years.

Nebraska officials are working with private “managed care organizations” that will provide health care services on the state’s behalf. Nebraska already uses their services for current Medicaid recipients, but officials now have to amend all of their contracts to cover the newly eligible.

Van Patton said any legislative bill that tries to modify the agency’s plan could lead to more delays. Some lawmakers and advocacy groups have criticized the department’s plan to go live on Oct. 1, 2020, as too slow. Van Patton defended the long timeline as necessary to make sure the launch runs smoothly.