How Trump’s Medicaid Work Requirements Could Disrupt Coverage for 70,000 Nebraskans

OMAHA, Nebraska has been bustling in recent days with the annual Berkshire Hathaway investor weekend, drawing tens of thousands of attendees to meet with Warren Buffett. But in one office, Amy Behnke, CEO of the Nebraska Health Center Association, has been focused on a far more urgent task: preventing some of the state’s poorest residents from losing their health insurance.

Behnke’s organization represents clinics serving Nebraska’s underserved population. Since 2020, she notes, the share of uninsured patients at member clinics has dropped from 50% to one-third—a sign of progress driven by Medicaid expansion.

In October 2020, Nebraska joined the Affordable Care Act’s Medicaid expansion after voters approved a ballot measure, allowing the state to cover citizens and qualifying legal residents earning up to 138% of the federal poverty line. The expansion has since provided coverage to over 70,000 Nebraskans.

However, as of May 1, 2025, these individuals are now subject to new work requirements under President Donald Trump’s “One Big Beautiful Bill,” signed into law in 2024. The legislation mandates states to implement work requirements by January 1, 2027. Nebraska, led by Republican Gov. Jim Pillen, has chosen to enforce them early, framing the policy as a way to ensure Medicaid serves as a “hand up, not a hand out.”

Who Will Be Affected by Nebraska’s Medicaid Work Requirements?

While the majority of non-elderly adult Nebraskans on Medicaid expansion already work or attend school, according to KFF estimates, the practical impact remains uncertain. Those who do not work may qualify for exemptions due to disabilities, caregiving responsibilities, or other factors. Yet the gap between policy and practice could lead to unintended coverage gaps.

“What is supposed to happen and what will happen are two very different things.”

Behnke’s efforts highlight the immediate challenges clinics may face if beneficiaries lose coverage due to administrative hurdles or misinterpretation of the rules.