Nebraska starts Medicaid work requirements early for 70,000 enrollees
Updated
Updated · POLITICO · May 3
Nebraska starts Medicaid work requirements early for 70,000 enrollees
13 articles · Updated · POLITICO · May 3
The state began enforcement on Friday, eight months before the federal deadline, with Medicaid director Drew Gonshorowski saying existing staff and Nebraska’s state-owned eligibility system can manage it.
Experts and advocates warned the rushed rollout, limited outreach and late guidance on medical exemptions could cause eligible people to lose coverage through red tape rather than ineligibility.
Nebraska is among several Republican-led expansion states adopting strict rules under the 2025 law; the Urban Institute estimates work requirements alone could strip coverage from 3 million to 7 million people nationwide.
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Nebraska became the first state to implement Medicaid work requirements in May 2026, requiring most adults on Medicaid expansion to complete 80 hours of work or qualifying activities monthly, with exemptions for vulnerable groups. The state relies on automated data matching and self-attestation for verification but has allocated no extra funding or staff, raising concerns about administrative burdens and insufficient outreach, especially for vulnerable and rural populations. Experts warn this could lead to significant coverage losses, with up to 25,000 Nebraskans at risk, echoing past failures in Arkansas and Georgia. Hospitals anticipate increased uncompensated care, while other states watch closely ahead of a nationwide mandate in 2027.