Nebraska Mandates Work for Medicaid Benefits

Nebraska became the first U.S. state to enact Medicaid work requirements on Friday, seven months ahead of a federal deadline. This policy applies to individuals enrolled in Medicaid through expansion, specifically those aged 19 to 64, who must demonstrate at least 80 hours of monthly work or community service, or be part-time students. Approximately 70,000 Nebraskans are enrolled via expansion, out of the state's 346,000 total Medicaid recipients.

Health care policy experts are monitoring Nebraska's implementation, as an estimated 25,000 enrollees, or 36% of those subject to the restrictions, could lose coverage. The Urban Institute projects that up to 10 million people nationally might lose Medicaid coverage within two years due to similar changes.

Exemptions exist for individuals with medical issues, pregnant women, and caregivers of disabled persons, but concerns remain regarding paperwork issues and the definition of exemptions like “medically frail.”

Three other states, Iowa, Montana, and Nebraska, plan to implement these requirements by year-end. Montana will begin enforcement on July 1, and Iowa on December 1. States are awaiting federal guidance on defining “medically frail” and are developing implementation plans, with some considering artificial intelligence for document processing. The federal mandate requires these rules to be instituted by January 1, 2027.