Eli McCreary, a 64-year-old Omaha resident, recently experienced the challenges firsthand. After being diagnosed with kidney cancer, he received a call from CHI Health, informing him that his Medicaid coverage had been terminated due to not meeting the new work requirements. McCreary, who has battled drug addiction for decades and has diabetes and chronic obstructive pulmonary disease, was told he needed to find a job to regain coverage. He expressed frustration, saying, "I don't understand what job I can get. I can't walk. I can hardly breathe. I can't move around. What job am I going to get?"
Nebraska launched its Medicaid work requirements on May 1, making it the first state to enforce the rules under the Trump administration's One Big Beautiful Bill Act. The requirements mandate that adult Medicaid recipients work or participate in a similar activity for 80 hours a month, unless they qualify for an exemption. About 70,000 adult Medicaid recipients in Nebraska are subject to the rules. State officials report that 86% of affected applicants met the requirement or qualified for an exclusion, and 93% of existing enrollees kept their coverage.
Despite these numbers, health clinics and organizations advocating for poor and working-class Nebraskans say the rollout has been problematic, citing poor training and inadequate staffing. Many enrollees are confused and have received inaccurate information about the rules. Nebraska Gov. Jim Pillen's administration has faced criticism for not adding workforce to implement the requirements and for instituting a government-wide hiring freeze.
The state has budgeted millions of dollars for government contractors to help implement the Medicaid changes, including work requirements and more frequent checks for eligibility. Documents obtained by KFF Health News show $8.2 million in contractor costs over two years, with two companies, Public Consulting Group and Covendis, providing staffing and IT support. One consultant praised Nebraska's implementation, while advocates argue that the costs and confusion are unnecessary.
The Medicaid work requirements are part of a broader effort to reform the program, which has been a contentious issue in Congress. Democrats have vowed to repeal the changes in their first 100 hours in office, but it is unclear if they will succeed, given the possibility of a presidential veto. Nebraska's experience may serve as a test case for the impact of work requirements on Medicaid enrollees.
Advocates for Medicaid enrollees say that the work requirements will curtail insurance gains made under the Affordable Care Act. The changes add reporting requirements and restrictions that make it harder for people to stay enrolled. As of early July, most denials related to the work requirements among Nebraska adults applying for Medicaid were due to incomplete or inaccurate information.
The implementation of Medicaid work requirements in Nebraska has raised concerns about access to healthcare for vulnerable populations. As the state continues to navigate the complexities of the new rules, advocates and officials will be watching closely to assess the impact on enrollees and the healthcare system as a whole. The outcome may have implications for other states considering similar reforms.
Key points
- Nebraska's Medicaid work requirements have caused confusion and access concerns for low-income residents.
- The state's rollout of the requirements has been criticized for poor training and inadequate staffing.
- Advocates argue that the changes will curtail insurance gains made under the Affordable Care Act.
