# Nebraska Expands Medicaid Specialized Care Access

Nebraska Governor Jim Pillen signed LB 1091, reforming Medicaid managed care by exempting high-acuity long-term specialized healthcare from prior authorization and shifting it to a direct fee-for-service model under the Nebraska Department of Health and Human Services (DHHS). This legislative change aims to streamline access to specialized rehabilitation and long-term care for patients with complex medical needs such as traumatic brain injuries and spinal cord injuries, while maintaining cost neutrality. The bill's implementation will require amendments to Medicaid managed care contracts within six months of the bill's effective date, creating new procurement and contract management opportunities for providers of specialized healthcare services in Nebraska.

- **Contracting implications:** Medicaid managed care contracts will be revised to exclude high-acuity long-term specialized care, transitioning these services to fee-for-service reimbursement, impacting contract scopes and payment structures.
- **Market opportunities:** Providers specializing in rehabilitation and long-term care, including entities like Quality Living, Inc., Madonna Rehabilitation Hospitals, and Ambassador Health, may see increased demand and contract opportunities.
- **Procurement planning:** Agencies and contractors should prepare for contract amendments and enrollment process changes under DHHS, aligning service delivery models with the new fee-for-service framework.
- **Policy impact:** This reform reflects a state-level shift toward improving access and timeliness of specialized healthcare services, signaling potential future procurement adjustments in Medicaid service delivery models.

**Jurisdictions:** sled
**Industries:** Healthcare
**Topics:** Regulatory Compliance
**Published:** September 16, 2026

### Government Entities
- Nebraska Department of Health and Human Services (DHHS)
- Nebraska Legislature
- Health and Human Services Committee
- Office of the Governor of Nebraska

### Vendors
- Quality Living, Inc. (Provider of specialized rehabilitation and care services)
- Madonna Rehabilitation Hospitals (Healthcare provider partner)
- Ambassador Health (Healthcare provider partner)

### Key Quotes
> LB 1091 reflects a simple but importance commitment 	6 Nebraskans living with traumatic brain injuries, spinal cord injuries, and other complex medical conditions deserve access to specialized care that gives them the best opportunity to reach their fullest potential and to do so with dignity.
> — Jim Pillen, Governor

> Passage of this legislation will ensure that Nebraskans with complex medical needs can access the highly specialized long-term care they need to recover, regain their independence and return home.
> — Elliot Bostar, Senator

### Sources
- [Gov. Pillen Holds Ceremonial Bill Signing for LB 1091 to Expand Access to Specialized Healthcare | Office of Governor Jim Pillen](https://governor.nebraska.gov/gov-pillen-holds-ceremonial-bill-signing-lb-1091-expand-access-specialized-healthcare) - NE