Nebraska launched Medicaid work requirements Friday, May 1, becoming the first state in the nation to enforce the policy mandated by last year’s One Big Beautiful Bill Act, eight months ahead of the January 1, 2027 federal deadline. About 70,000 Nebraskans enrolled in Medicaid expansion must now demonstrate at least 80 hours per month of employment, job training, volunteering, or school attendance to maintain coverage. Individuals earning at least $580 per month — roughly equivalent to 80 hours at the federal minimum wage — also satisfy the requirement.
Gov. Jim Pillen announced Nebraska’s intent to implement early in December alongside Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz. The rule applies to able-bodied adults ages 19 to 64 in the Medicaid expansion population — those with incomes up to 138 percent of the federal poverty level. Standard Medicaid enrollees including children, pregnant women, and individuals with disabilities are exempt, as are people considered medically frail.
The Urban Institute estimated the policy will strip coverage from approximately 25,000 Nebraska residents. The Center on Budget and Policy Priorities placed the figure between 28,000 and 41,000. Nebraska’s Department of Health and Human Services disputes those projections, arguing its data systems will allow most eligible enrollees to be verified without requiring paperwork submissions. No new staff were hired to support implementation and no additional state funding was allocated — DHHS said federal implementation grants will cover administrative costs. DHHS Medicaid Director Drew Gonshorowski said the department has a structured governance process to monitor coverage continuity.
Advocates for the poor and hospital groups said many eligible Nebraskans are unaware of the new requirements or the documentation needed to maintain coverage. Nebraska’s unemployment rate is 3.1 percent, one of the lowest in the country. Montana will begin enforcing work requirements July 1, Iowa on December 1.
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