Nebraska enforces Medicaid work rules

Nebraska will begin enforcing Medicaid work requirements on May 1, becoming the first state to put the new federal rules into effect. (dhhs.ne.gov) (usnews.com) The rules apply to adults covered through Nebraska’s Medicaid expansion, not to every Medicaid enrollee in the state. New applicants after May 1 must show they met the requirement in the month before they apply. (dhhs.ne.gov) Nebraska says people can qualify by logging at least 80 hours in a month through paid work, school, an apprenticeship, a work program, or volunteer service. The state also says a person can qualify by earning about $580 in a month, the equivalent of 80 hours at the federal minimum wage. (dhhs.ne.gov 1) (dhhs.ne.gov 2) Existing expansion members will not all be reviewed on May 1. Nebraska says it will start checking work compliance during renewals for people whose annual eligibility periods end on or after July 31, 2026. (dhhs.ne.gov) Nebraska moved ahead of the federal deadline built into H.R. 1, the 2025 reconciliation law signed on July 4, 2025. KFF says states must apply work requirements by January 1, 2027, but can start sooner through a state plan amendment or waiver. (kff.org) (dhhs.ne.gov) The scale is large even though many people already work or would be exempt. KFF says about 72,000 Nebraska expansion enrollees could be affected, and roughly 65% of Medicaid adults without dependent children who could face the rule already work 80 hours a month or attend school. (kff.org) That is why the fight is less about whether people work than about whether they can prove it. Nebraska says it will try to use data it already has, then contact people if it needs more information. (dhhs.ne.gov) The state lists exemptions for people with serious disabilities or medical frailty, pregnancy and the 12 months after birth, some caregivers, tribal members, and people in certain households already meeting work rules through Supplemental Nutrition Assistance Program or Temporary Assistance for Needy Families. (dhhs.ne.gov 1) (dhhs.ne.gov 2) Supporters, including Governor Jim Pillen and federal officials, have framed the policy as aligning Medicaid with work and community engagement. Critics, including Families USA and Legal Aid of Nebraska, say the compressed rollout raises the risk that eligible people will lose coverage over paperwork, reporting, or system problems. (governor.nebraska.gov) (familiesusa.org) (legalaidofnebraska.org) Past evidence from Arkansas hangs over the rollout. KFF says more than 18,000 people lost Medicaid coverage there in 2018 under work-reporting rules, and a New England Journal of Medicine study found coverage fell without an increase in employment. (kff.org) (nejm.org) Another problem is measurement. STAT reported on April 28 that the federal law does not require states to track how many people lose Medicaid because of work requirements or to break out the reasons, leaving outside groups and researchers to piece together the effects. (statnews.com) So Nebraska’s May 1 launch is not just a state policy change. It is the first real test of how the new national Medicaid work rules will function before the rest of the country reaches the 2027 deadline. (kff.org)