Nebraska became the first U.S. state to impose Medicaid work requirements eight months before the GOP’s One Big Beautiful Bill deadline to do so.
The new rules, enacted Friday, apply to people who qualified for Medicaid under an expansion requiring able-bodied adults ages 19 to 64 to engage in work or other qualifying activities as a condition of receiving benefits under the government health insurance program.
About 70,000 Nebraskans enrolled in Medicaid through the expansion, and the move could cut around 25,000 residents who qualified under the expansion, according to the Urban Institute, a nonpartisan research group.
The expansion requires that enrollees work or perform community service for at least 80 hours a month, or be at least part-time students, with some exemptions. New Medicaid enrollees must now submit proof, and those already on the health insurance program will have until at least the end of July to do so.
Nebraska Republican Gov. Jim Pillen, alongside Centers for Medicare and Medicaid Services administrator Dr. Mehmet Oz, announced in December the state’s goal of implementing the work requirements by May 1.
“These requirements will help Nebraskans achieve greater self-sufficiency through employment and other meaningful activities,” Mr. Pillen said at the time. “Working not only provides purpose but helps people become active, productive members of their communities.”
Republicans have compared the work requirements as a way to identify waste, fraud and abuse in the Medicaid program.
If enrollees do not submit their information within a month of being notified, they may be denied or lose coverage, according to the Nebraska health department.
Nebraska officials said they have been working closely with CMS at every stage of implementation.
“CMS has worked with DHHS every step of the way to make sure we were implementing work requirements right,” Jeff Powell, spokesperson for Nebraska’s Department of Health and Human Services, told The Hill.
Under President Trump’s signature One Big Beautiful Bill, states are not required to mandate the work requirements until Jan. 1, 2027.
Prior rollouts in Arkansas and Georgia in 2018 and 2023, respectively, led to significant coverage losses and sustained drops in enrollment, generating substantial costs for both states
Iowa and Montana plan to enact the Medicaid work requirements by the end of the year; Montana has signaled it will start enforcing the rules on July 1, while Iowa said it will implement them in December.
By being the first state to move forward with the work requirements, Nebraska will act as a guinea pig regarding how the Republican effort will take shape.
