Nebraska to Implement Medicaid Work Requirements, Affecting 30,000 Residents
Nebraska is set to become the first state to introduce new work requirements for certain Medicaid beneficiaries, with the policy taking effect on May 1. This move, announced by Governor Jim Pillen, a Republican, will impact approximately 30,000 people with slightly higher incomes than traditional Medicaid recipients. The aim, according to Pillen, is not to penalize individuals but to encourage able-bodied Nebraskans to contribute to their community.
The policy is a result of a law signed by President Donald Trump in 2023, which mandates that states ensure many Medicaid recipients are working by 2027, although states have the option to implement the requirement sooner. The law applies to people aged 19 to 64 who have Medicaid coverage, requiring them to work or perform community service for at least 80 hours a month, or be enrolled in school at least half-time, to maintain their coverage.
FILE – Centers for Medicare & Medicaid Services administrator Dr. Mehmet Oz listens as President Donald Trump speaks in the Oval Office of the White House, Oct. 16, 2025, in Washington. (AP Photo/Alex Brandon, File)
Exemptions and Reporting Requirements
Certain individuals will be exempt from the work requirements, including disabled veterans, pregnant women, parents and guardians of dependent children under 14, disabled individuals, people recently released from incarceration, those who are homeless, and individuals receiving addiction treatment. States can also offer short-term hardships for others if they choose. All Medicaid beneficiaries eligible due to the expansion will need to submit paperwork every six months to demonstrate they meet the mandate, with those who fail to do so risking loss of coverage.
The reporting requirement is twice as frequent as it is for most people covered by Medicaid, meaning more work for state agencies and potentially expensive computer program updates. However, Governor Pillen does not expect the state government to increase staffing to implement the changes.
Expected Outcomes and National Implications
The nonpartisan Congressional Budget Office estimates that the requirement will reduce Medicaid costs by $326 billion over a decade but will result in 4.5 million people becoming uninsured each year starting in 2027. Currently, about 77 million Americans are covered by Medicaid. The policy is not expected to increase employment rates, as most Medicaid recipients who are able to work already do. Mehmet Oz, the administrator of the Centers for Medicare and Medicaid Services, believes there are jobs available across the country, and the challenge is connecting people with them.
Other states, such as Georgia and Arkansas, have implemented similar Medicaid work requirements, with mixed results. Georgia’s implementation in 2023 saw fewer people covered than projected, partly due to the work and reporting requirements. Arkansas’s attempt at introducing work requirements in 2018 was blocked by a judge after 18,000 people were kicked off coverage in the first seven months.
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