Nebraska became the first state to implement Medicaid work requirements on May 1, 2026, requiring certain enrollees to prove they work, train, or attend school. The mandate stems from the One Big Beautiful Bill Act signed by President Trump in July 2025. Officials aim to ease compliance, but enrollees and advocates fear coverage losses due to paperwork hurdles.
Nebraska's Medicaid program began enforcing work requirements on Friday, May 1, affecting about 70,000 enrollees in the state's expansion population. Under the federal law, adults must complete at least 80 hours per month of work, volunteering, schooling, or job training, or qualify for exemptions like caring for young children or medical conditions. State spokesperson Collin Spilinek noted that 72% of those affected already meet the criteria through existing databases, sparing them from action. Enrollees without verified data will receive notifications to submit online forms, with self-attestation allowed for exemptions without supporting documents required, according to Spilinek. Nebraska Medicaid Director Drew Gonshorowski emphasized in an early-April release that the priority is ensuring members understand changes to retain coverage, with exemptions for thousands of health conditions listed by the state. Centers for Medicare & Medicaid Services Administrator Mehmet Oz praised Nebraska's early start during an April 28 interview, saying the state is 'working out the kinks' and expected to improve by year's end. Schmeeka Simpson, a 46-year-old Omaha resident holding three jobs, expressed worry about losing coverage despite her employment, citing past issues with paperwork for food assistance. 'Adding more barriers won't make the program work any better,' she said. Crystal Schroer, unemployed due to anxiety managed by a service dog, called herself 'insanely worried' about her exemption status. Hospital leaders and advocates share the concerns. Jeremy Nordquist, president of the Nebraska Hospital Association, highlighted fears of unaware enrollees losing insurance and hospitals facing uninsured patients. Nebraska Appleseed attorney Kelsey Arends criticized the exemption list as incomplete. The Congressional Budget Office projects 4.8 million nationwide will lose coverage over the next decade. Only Montana and Iowa plan early rollouts before the 2027 deadline for 42 states and the District of Columbia.
