Nebraska Leads with Medicaid Work Requirements: What It Means for 70,000 Residents

On Friday, Nebraska became the first state to enact Medicaid work requirements, a mandate tied to Trump’s One Big Beautiful Bill Act for states with Medicaid expansion. The state implemented the policy seven months before the January 1, 2027 deadline.

Now, approximately 70,000 adults under 65 in Nebraska who receive Medicaid through the state’s expansion program could lose their health insurance coverage. Research shows Medicaid work requirements do not increase employment rates. Instead, they create administrative hurdles that disproportionately strip healthcare from those who need it most.

A majority of Medicaid recipients who are not on Supplemental Security Income already work full- or part-time jobs. This fact underscores the flawed premise behind work requirement policies.

Criticism of Nebraska’s Early Implementation

The Center on Budget and Policy Priorities criticized Nebraska’s early rollout, stating there is insufficient time to implement fairer systems. The center urged policymakers to withdraw the requirements entirely. If not, the group argued, states must be given more time to ensure their systems minimize harm to eligible individuals.

Nebraska’s decision to implement work requirements before the interim rule from Health and Human Services Secretary Robert F. Kennedy Jr.—due June 1—further highlights the policy’s cruelty. Concerns persist about how the rule may define “able-bodied” individuals, potentially excluding those with chronic illnesses or autoimmune diseases from exemptions.

A person with debilitating chronic pain or a serious autoimmune illness may appear ‘able-bodied’ under standards RFK Jr. appears poised to implement—even as they face barriers qualifying for Social Security disability due to not being considered disabled enough.

When asked for comment, an HHS spokesperson declined to address specific questions. Instead, the agency issued a general statement affirming its commitment to protecting and strengthening Medicaid while eliminating waste, fraud, and abuse.

Exemptions and Gaps in Coverage

Nebraska’s Medicaid work requirements include exemptions for individuals with chronic illnesses and pregnant people. However, exemptions are reviewed only every six months, and the list of qualifying conditions is incomplete. Long Covid, a post-infectious disease that can severely impair work ability, is notably absent from the exemption list.

Expert Warnings and Future Implications

“I don’t see how any state could protect people with disabilities from these kinds of cuts,” said Edwin Park, a professor at Georgetown University, in remarks made last year before Republicans advanced Medicaid work requirements and nearly $1 trillion in Medicaid cuts.

As Nebraska leads the charge, the nation watches to see how other states implement—or expand—these policies, raising concerns about their potential impact on vulnerable populations.