LINCOLN, Neb. (AP) — Nebraska residents who qualify for expanded Medicaid under the federal health care law can start enrolling next month, Gov. Pete Ricketts said Monday as he defended the state's nearly two-year time frame to offer coverage after voters approved it.

Ricketts said Nebraska will open enrollment on Aug. 1, and coverage will begin as scheduled on Oct. 1.

The roll-out begins nearly two years after Nebraska voters approved a measure to expand Medicaid coverage in the November 2018 election over the objections of Ricketts and conservative groups. Nebraska lawmakers and governors repeatedly rejected attempts to expand coverage, prompting a statewide ballot campaign that won with 54% support, mostly from the Omaha and Lincoln areas.

The unusually slow implementation has drawn criticism and lawsuits from supporters of Medicaid expansion, which will cover an estimated 90,000 low-income adults in Nebraska. Supporters argue that the nearly two-year wait since the election left many residents in limbo as they waited for coverage. They also say Nebraska lost out on federal matching dollars that the state would have received with an earlier implementation.

Ricketts defended the implementation period at a news conference to announce the enrollment date, saying he wanted to avoid the fate of states including California, which enrolled more than 366,000 people who weren't eligible.

State officials took their time to ensure “that we’re putting the people who are supposed to be in the program in there and not the people who don’t belong there,” Ricketts said.

Nebraska Medicaid Interim Director Jeremy Brunssen said the state has hired an additional 68 employees to help determine whether applicants are eligible for coverage, plus another 55 call center agents who will help process claims. Brunssen said he expects to be able to launch the program without further delays.

“We feel very confident that we're in a great position to process applications,” he said.

Once in place, the expansion will cover adults ages 19 to 64 who earn up to 138% of the federal poverty level — about $17,600 a year for one person and $36,150 annually for a family of four.

Some of the skepticism in Nebraska stems from Republicans’ long objections to expanding Medicaid under the federal health care law championed by Democratic former President Barack Obama. Medicaid, which provides health coverage for lower-income and disabled Americans, is funded jointly by states and the federal government. The 2010 Affordable Care Act encouraged states to expand Medicaid by promising that the federal government would cover most of the cost.

Shortly after Nebraska voters approved Medicaid expansion, state officials announced a two-tiered system of coverage, with a “basic” plan for all newly qualified recipients and a “premium” plan for people who are working, in school, volunteering or caring for a relative.

The basic plan includes coverage for hospitalizations, emergency care, prescription drugs, lab tests, maternity care and other services. The premium plan offers those benefits as well but adds coverage for dental and vision services, and over-the-counter drugs.

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