Nebraska is set to implement work requirements for Medicaid enrollees starting this Friday, becoming the first state to do so following the passage of the “One Big Beautiful Bill Act” in 2023.
This policy, which requires low-income adults enrolled in Medicaid expansion to meet work or work-related activities, has sparked significant debate and concern among both advocates and experts about the potential impact on vulnerable populations.
The New Work Requirement
The new mandate, enacted as part of a broader federal push by the Trump administration to introduce work requirements into Medicaid, will require adults aged 19 to 64 who are covered under Medicaid expansion to either work, volunteer, attend school, or participate in a work program for at least 80 hours a month.
Exemptions are provided for pregnant women, parents of children under 14, medically frail individuals, and those in treatment for substance use disorder.
In Nebraska, individuals applying for Medicaid expansion must demonstrate they meet these work requirements before enrolling, or show they qualify for an exemption. Existing enrollees will need to meet the requirement during their annual renewal process, starting July 31, 2026.
To meet the 80-hour requirement, an enrollee can either provide documentation of their employment or income (e.g., earning at least $580 a month, equivalent to 80 hours of work at the federal minimum wage), or show proof of participation in other qualifying activities like volunteering, attending school, or being part of a work program.
Concerns Over Administrative Hurdles and Loss of Coverage
While supporters of the policy argue it will encourage long-term independence and self-sufficiency, critics say it could lead to many eligible Nebraskans losing their coverage due to the added paperwork burden and lack of clear communication.
The state’s process for determining eligibility and compliance is seen as cumbersome, with enrollees needing to provide various documents and attestations to prove their eligibility.
Jennifer Tolbert, deputy director of the Program on Medicaid and the Uninsured, expressed concern about the documentation challenges that many individuals will face, particularly those who are already struggling to navigate the system.
“For some people, there is going to be a significant documentation hurdle,” Tolbert said. “That could mean those individuals, even though they are meeting the requirements, are simply not able to enroll because they can’t provide the documentation.”
Sarah Maresh, the health care access program director at Nebraska Appleseed, an advocacy group, added that many residents are confused about whether the work requirement applies to them or if they qualify for exemptions.
She criticized the state’s outreach efforts, saying the notices sent to enrollees have been vague and difficult to understand. “This rush job will lead to a lot of harm,” Maresh warned.
Impact on Health Providers and Rural Areas
Hospitals and health care providers, especially in rural areas, are concerned that the rushed implementation of the work requirement could lead to a large number of patients losing their Medicaid coverage.
This could create disruptions in care, particularly for those who rely on Medicaid for access to health services. The Nebraska Hospital Association has expressed concerns about the potential financial losses that could result from these disruptions and the increased administrative burden that providers will face as they work to navigate the new rules.
State’s Response and Outreach Efforts
The Nebraska Department of Health and Human Services (DHHS), which oversees Medicaid in the state, has stated that it is committed to increasing outreach to ensure that enrollees understand the changes.
DHHS has launched a communications campaign, including sending tens of thousands of mail, email, and text messages to enrollees, as well as using television, radio, and social media to raise awareness about the work requirements.
Drew Gonshorowski, director of the Division of Medicaid and Long-Term Care, emphasized that the state’s priority is ensuring that enrollees clearly understand the new rules and how to maintain their coverage. “Our top priority is making sure members clearly understand changes to the program and how to maintain their coverage,” Gonshorowski said in a press release.
Projected Impact on Medicaid Enrollment
The new work requirement could lead to a significant decline in Medicaid enrollment in Nebraska. An analysis by the Urban Institute estimates that between 16,000 and 30,000 Nebraskans could lose their coverage by 2028 as a result of the work requirement.
Additionally, a new federal provision that requires states to redetermine Medicaid eligibility every six months, rather than annually, could contribute to further loss of coverage as people fail to meet the requirements or miss deadlines.
In total, the Urban Institute projects that the new work requirement will lead to the loss of between 3 million and 7 million Medicaid enrollees across the country by 2028.
Nebraska’s implementation of the work requirement for Medicaid marks a significant shift in the way the state administers its Medicaid expansion program, making it the first state to adopt this key pillar of the “One Big Beautiful Bill Act.” While proponents argue that the policy will encourage independence, critics raise concerns about its impact on vulnerable populations, particularly low-income families and individuals facing bureaucratic hurdles.
As Nebraska moves forward with these changes, the state’s ability to effectively communicate with enrollees and mitigate the risk of losing coverage will be critical to ensuring that the policy achieves its intended goals without inadvertently harming those who depend on Medicaid for healthcare access.
