At the turn of the month, hundreds of Nebraskans receiving health insurance through the state’s Medicaid program were notified they would no longer be covered, due to the implementation of the program’s new work requirements.
Nebraska is the first state in the nation to enact these new federal requirements, initially laid out and mandated by H.R. 1, also known as the One Big Beautiful Bill Act. In Dec. 2025, Gov. Jim Pillen signed a letter detailing the state would put the requirements in place on May 1, 2026, months ahead of the federal deadline of Jan. 1, 2027. Additionally, H.R. 1 cuts roughly $1 trillion in Medicaid funding over the next 10 years—representing roughly 11% of the program’s total spending.
Under the implementation calendar, new applicants started facing the updated rules on May 1, but on Aug. 1, the state began the process of disenrolling existing Medicaid participants who failed to meet the requirements.
Drew Gonshorowski, the director of Nebraska’s Division of Medicaid and Long-Term Care, said in an interview with the nonprofit health policy news outlet Tradeoffs that the initial wave of disenrollments would include around 200 Nebraskans, but the exact figure wouldn’t be known until the end of July.
It’s estimated that over 70,000 Nebraskans are enrolled in the state’s Medicaid expansion program.
The Nebraska Department of Health and Human Services (DHHS) has not responded to Courier Nebraska’s request for comment on that exact figure at this time.
What are the requirements?
The new federal work requirements going into effect in Nebraska specifically apply to the Medicaid expansion program, not traditional Medicaid.
While traditional Medicaid is a joint federal-state program that helps pay for medical costs for specific low-income groups, Medicaid expansion raises that low-income threshold for all adults aged 19 to 64 to 138% of the federal poverty level, regardless of whether they have children or disabilities.
The new requirements dictate that able-bodied adults in the Medicaid expansion population must participate in 80 hours of work, approved work programs, community service, or educational activities per month to maintain their benefits.
Some people may be exempt from these work requirements if they meet certain conditions, such as blindness, having a complex medical condition, or a serious developmental disability.
Nebraska, specifically, fought for Medicaid expansion, too. In 2018, voters approved Initiative 427 by 53.55% at the ballot box, requiring Nebraska DHHS to file a state expansion plan with the federal Centers for Medicare and Medicaid Services. This came about eight years after Medicaid expansion was created by the Affordable Care Act in 2010.
Human impact
These new work requirements, and Nebraska’s decision to implement them early, have caused much “confusion and concern” for recipients, according to Kelsey Arends, a senior staff attorney for Health Care Access with Nebraska Appleseed, a nonpartisan nonprofit group focused on civic engagement. Arends joined affected patients and other advocates for a webinar last week to detail how these changes are impacting Nebraskans.
“Nebraskans are feeling the pinch in many different directions, and health care is no exception,” said Arends. “This program is for people who have no other options for healthcare coverage. The uninsured rate dropped in Nebraska by nearly 15% in the first two years after Medicaid expanded. We saw hospitals experience a $20 million reduction in the amount of financial assistance or uncompensated care that they had to write off. And we saw Nebraskans’ individual bankruptcy filings decrease by 23.5%, outpacing the national average. These economic benefits were even more pronounced in rural areas.”
Rural hospitals in Nebraska rely heavily on Medicaid to meet their revenue needs. According to First Five Nebraska, nearly half of the state’s Medicaid enrollees live in rural areas and 44% of rural hospitals operate at a loss already—making cuts to the program more substantial.
Arends also underscored that a majority of Medicaid enrollees are already working, dispelling the notion frequently platformed by Republican office holders that tighter Medicaid restrictions are needed to stop able-bodied adults from taking advantage of government resources.
“Further, evidence shows that work requirements do not positively impact workforce participation,” Arends said. “Instead, what they do is make it easy for folks to lose coverage, suffer worse health outcomes, and be less likely to be able to work. So the work requirements are a solution in search of a problem that doesn’t exist, and the cost of the health of our neighbors and the support of our health systems is going to be really extreme.”
More disenrollments from Medicaid expansion in Nebraska are likely on the horizon, as review periods for enrollees vary. While DHHS began checking work requirements for members whose coverage periods ended on July 31, each member will be checked in their own renewal month over the next year.
“It’s an effective program. We’ve consistently seen that when folks have reliable access to healthcare, their individual health improves, as does the health of our communities and their families,” said Arends. “Folks who lose their coverage will face the really destabilizing impact of losing their coverage.”
H.R. 1 received support from all five members of Nebraska’s congressional delegation—Sens. Pete Ricketts and Deb Fischer, and House Reps. Mike Flood, Don Bacon, and Adrian Smith.
More information on work requirements for Nebraska’s Medicaid expansion program can be found at dhhs.ne.gov. For more resources from Nebraska Appleseed, visit neappleseed.org.
