Nebraska Enforces New Medicaid Work Requirements

Nebraska is the first state in the U.S. to enforce Medicaid work requirements, a policy signed into law by President Trump in 2025. This change, effective on Saturday, will remove roughly 200 Nebraskans from Medicaid if they fail to meet the new criteria.

The state’s Medicaid Director, Drew Gonshorowski, explained to Tradeoffs that they’ve implemented multiple checks before any individual loses coverage. The goal is to prevent individuals from being unnecessarily affected. Starting August 1st, Nebraska will remove people from Medicaid if they do not comply with work or volunteer requirements of 80 hours per month, attend school, or participate in job training. Individuals exempt from these rules include those with disabilities, serious illnesses, and caregivers of young children.

The work requirements, introduced last year, aim to foster economic stability and save the federal government $325 billion over ten years. Nebraska has chosen to implement these requirements ahead of the January 1 deadline. Gonshorowski believes this proactivity supports economic stability and offers opportunities for Medicaid recipients.

While supporters see potential benefits, critics argue that past work requirements did not result in increased employment. Some individuals lost coverage due to unawareness of new rules or administrative obstacles. Estimates suggest that nationwide, 3 to 8.6 million people might lose coverage by 2028, including 30,000 in Nebraska.

Nebraska has positioned itself to efficiently handle these changes, partly due to its ability to manage eligibility through its system without requiring additional information from beneficiaries. About 70,000 state residents are subject to these new requirements.

The state has actively communicated these changes through letters, text messages, and media advertisements. However, advocates, such as Amy Behnke of the Health Center Association of Nebraska, have raised concerns about the clarity of these communications. Testing of the state’s Medicaid helpline revealed issues with response times and service for Spanish-speaking callers. Nebraska reports an average wait time of 10 minutes and holds regular meetings with federal officials to address communication challenges.

As the policy takes effect, Gonshorowski is monitoring the number of affected individuals seeking appeals or fair hearings to contest their Medicaid termination. He emphasizes the importance of accurate implementation, as errors might overlook factors like disabilities or earned income.

Nebraska is collaborating with the state’s labor department to offer job connections for those losing coverage. Gonshorowski sees an opportunity in utilizing new data streams to assist residents positively amid the controversy surrounding these changes.