Nebraska Implements Federal Medicaid Work Requirements First

Nebraska became the first state to implement federal Medicaid work requirements on Friday, following mandates from President Trump's tax and spending bill passed last summer. The requirements apply to able-bodied recipients aged 19 to 64 without dependents, requiring 80 hours per month of work, schooling, volunteering, or other approved activities.

Exemptions include parents or guardians of children under age 14 and those with disabilities. The Congressional Budget Office estimated that the policy could lead to 5.2 million Americans losing Medicaid coverage nationwide by 2034, increasing the number of uninsured by 4.8 million.

A report from the Center for Budget and Policy Priorities indicated that between 28,000 and 41,000 Nebraskans are at risk of losing coverage by that year. The bill includes broader changes, such as requiring states to conduct eligibility redeterminations every six months instead of annually, prohibiting state funds for covering undocumented immigrants, and increasing paperwork for income and residency verification.

Health policy experts expressed concerns about the effects on vulnerable populations. Sara Rosenbaum, professor emerita of health law and policy at George Washington University's Milken Institute School of Public Health, highlighted risks to individuals with chronic conditions going untreated.

Dr. Benjamin Sommers, a professor of medicine at Harvard Medical School, noted challenges for those with variable job hours or multiple gigs in proving compliance.

“People should be aware of what's going to happen to their neighbors ... the people who clean their houses, the people that pick their crops. These are the people who are about to lose their health care.”

The bill cuts Medicaid funding by more than $900 billion over the next decade, according to the Congressional Budget Office. Republicans stated the cuts aim to reduce waste, fraud, and abuse, while funding tax cuts and increases for border security and defense.

House Speaker Mike Johnson defended the work requirements as common sense, questioning why able-bodied individuals could not commit to 20 hours per week of work or volunteering.

State and Federal Responses Republican Nebraska Gov.

Jim Pillen announced the implementation, stating it encourages workforce participation among able-bodied adults. About two-thirds of non-elderly, non-disabled adult Medicaid enrollees in Nebraska already work or attend school, according to KFF data from early 2026.

White House spokesman Kush Desai stated that the policy fulfills President Trump's pledge to preserve Medicaid as a lifeline while promoting employment.

“Welfare should be a hand up, not a hand out, and this will encourage able-bodied adults to join the workforce -- and ultimately help these folks know that their contributions to our state make a difference.”

Experts raised alarms about potential closures of rural hospitals and community health centers due to lost Medicaid revenue. The bill provides a $50 billion rural health stabilization fund, though its sufficiency remains unclear. Sommers emphasized harms to patients losing coverage and to healthcare providers facing financial distress.

The Washington Times reported the implementation occurred eight months before the deadline set in the bill, referred to there as the GOP's One Big Beautiful Bill Act. ABC News coverage aligned on the timing and details but included additional expert analyses on health and economic effects.

No contradictions appeared between the sources on core facts.