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By Sam Stevenson
Associate News Editor
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Nebraska is set to become the first U.S. state to implement new Medicaid work requirements following the passage of a federal law signed by President Donald Trump in July 2025.
Why It Matters
The rollout marks a major shift in how Medicaid, a federal-state program that insures low-income Americans, is administered and foreshadows similar policies that could follow nationwide.
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What To Know
Nebraska will require certain Medicaid recipients—specifically, able-bodied adults aged 19 to 64 who qualify under the state’s Medicaid expansion, covering those with a slightly higher income limit—to provide proof of 80 hours per month of employment or community service.
Alternatively, eligible recipients must be enrolled in school at least half-time to maintain coverage.
The requirements are part of the broader 'One Big Beautiful Bill', which mandates states to adopt work requirements for Medicaid by 2027 but permits earlier adoption.
Nebraska is the first state to act ahead of the deadline.
Of the approximately 346,000 Nebraskans enrolled in Medicaid as of May, about 72,000 fall into the higher-income expansion group potentially subject to the new rule.
Exemptions include disabled veterans, pregnant women, primary caregivers of children under 14 or disabled dependents, the recently incarcerated, homeless individuals, and those receiving addiction treatment.
Nebraska’s Republican Governor Jim Pillen stated that no additional state staff will be hired for the rollout, and the state will rely on existing resources and technology to process the new administrative workload.
Federal projections raise concerns about coverage loss. The Congressional Budget Office estimates the requirements will result in 4.5 million Americans becoming uninsured each year starting in 2027.
What People Are Saying
Governor Jim Pillen said: "We’re not here to take everybody to the curb [but we're] making sure we get every able-bodied Nebraskan to be part of our community. This is a hand up, not a handout. It's a key piece of giving the discipline for our families to be successful. It's a key piece of self-worth. It's a key piece of mental health and stability.”
Dr. Mehmet Oz, Administrator of the Centers for Medicare and Medicaid Services, said: "So, there actually is work to do. We just got to get it to people who are struggling to find their way with the job opportunities that can allow them to get back on their feet and get back into full employment."
Edison McDonald, executive director of National Disability Action, said: "When people lose Medicaid, they do not become more employable. They become sicker, less stable and more likely to fall out of the workforce entirely. Nebraska should fix access and capacity problems before layering on policies that will push vulnerable people off care."
Nebraska Appleseed Health Care Access Program Director Sarah Maresh said: "This is a mistake. We have seen in other states that when Medicaid work requirements are implemented too quickly, like what Nebraska is proposing here, thousands of people who are eligible for the program unnecessarily lose coverage and millions of state dollars are wasted on ineffective administrative costs.
"We know a vast majority of Nebraskans subject to these requirements work or meet an exemption to work requirements, but rushing to implement work requirements will cause them to lose coverage anyway. The fact that the Governor is already estimating that 30,000 people will lose their coverage proves that our state is not prepared or ready for the task ahead of them. Our state should take its time to implement the requirements set by H.R.1 to ensure that all eligible Nebraskans maintain the health care coverage they need."
What Happens Next
Nebraska’s Department of Health and Human Services and Department of Labor will coordinate the implementation, notify around 70,000 affected residents by early January 2026, and finalize the blueprint for tracking work status by May.
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