Nebraska will become the first state to enforce Medicaid work requirements under a Trump law, affecting 30,000 people and reshaping coverage as new rules roll.
Work Requirements Take Effect May 1
Gov. Jim Pillen announced that the new mandate will start on May 1 and could affect roughly 30,000 Nebraskans whose incomes sit just above the traditional Medicaid threshold. “We’re not out here to take everybody to the curb,” Pillen said, adding that the goal is to ensure “every able-bodied Nebraskan…be a part of our community.”
Who Must Comply and What Is Expected
The Trump-signed sweeping tax and policy law, enacted in July last year, requires states to make sure many recipients are working by 2027 but allows them to begin earlier. Under the new rule, people aged 19 to 64 who receive Medicaid through the expansion must work or do community service for at least 80 hours a month, or enroll in school at least half-time, to keep coverage.
Exemptions and Reporting
Only those who qualify under the expansion-about 72,000 of Nebraska’s 346,000 Medicaid enrollees as of May-are subject to the mandate. Exemptions include disabled veterans, pregnant women, parents or guardians of children under 14, disabled individuals, people recently released from incarceration, and those receiving addiction treatment. States may also grant short-term hardship waivers.
Beneficiaries will need to submit paperwork every six months to prove compliance. The reporting frequency is twice that of most Medicaid enrollees, adding administrative burden and likely prompting costly computer system updates. Pillen said the state does not expect to add staff to manage the changes.
Impact and Estimates
The Congressional Budget Office projects that the requirement will cut Medicaid spending by $326 billion over ten years and cause 7.5 million Americans to lose coverage by 2034, while the current Medicaid population stands at about 77 million.
Because most able-bodied Medicaid recipients already work, the policy is not expected to raise employment rates. CMS administrator Mehmet Oz, speaking via video feed, noted that jobs exist nationwide and the challenge is connecting people with them: “Most people who are able-bodied on Medicaid actually are trying to get a job.”
State and National Context
Georgia adopted similar work requirements in 2023, and fewer people are covered than projected, partly due to the reporting and work obligations. Arkansas implemented a different variation that was later blocked by a judge; it saw 18,000 people lose coverage in the first seven months after it began in 2018.
Nebraska’s move will likely spark discussions among governors and lawmakers nationwide as legislative sessions start in January.
Key Takeaways
- Nebraska’s Medicaid work mandate will begin May 1 and could affect about 30,000 residents.
- Only expansion-eligible enrollees-roughly 72,000-must meet the 80-hour work or school requirement and report biannually.
- The policy is projected to save $326 billion in Medicaid costs but could leave 7.5 million Americans uninsured by 2034.
Nebraska’s implementation of the Trump-era work requirement marks a significant shift in state Medicaid policy, raising questions about coverage, administration, and the balance between work incentives and access to health care.
