Nebraska Begins Medicaid Work Requirements Eight Months Ahead of Federal Deadline

Nebraska began enforcing new Medicaid work requirements on May 1, eight months before the federal deadline of January 1, 2027. The Health Center Association of Nebraska recorded zero new Medicaid enrollments in May, compared with its usual average of 15 per month.

CEO Amy Behnke said applicants appear to be staying away because they assume the new rules make them ineligible or find the process too difficult. New applicants must now show they met the requirements in the month before applying.

The rules apply to adults in Medicaid expansion programs in 43 states and Washington, D.C. Enrollees must document at least 80 hours per month of paid work, community service, a work program, or half-time school enrollment. They can also qualify by earning at least $580 monthly at the federal minimum wage.

Parents of children age 13 and younger, veterans with disabilities, pregnant people, and those in substance-use treatment are exempt. The federal government also created a "medically frail" category for people whose conditions significantly impair their ability to meet the requirements.

Starting in 2027, states must verify compliance at least once every six months. Enrollees who cannot be verified receive 30 days to submit documentation before losing coverage.

Nebraska is reviewing only the primary diagnosis code on claims from the prior 12 months when assessing medical frailty. Behnke noted that visits for minor issues may omit other qualifying conditions such as diabetes or anxiety. Jennifer Tolbert of KFF said states vary in the data sources they can access for verification, including wage records and student enrollment data.