Nebraska’s Medicaid Work Mandate Sparks Concerns Over Coverage Loss

Schmeeka Simpson, a 46-year-old resident of Omaha, Nebraska, juggles three jobs: patient navigator for the American Civil Liberties Union, administrative assistant at Nebraskans for Peace, and part-time shifts at a Dunkin’ shop. Despite her employment, Simpson relies on Medicaid for health coverage since her divorce in 2014. None of her employers offer health insurance.

Her concerns deepen as Nebraska prepares to become the first state to enforce work requirements for certain Medicaid enrollees starting May 1. The mandate, part of the One Big Beautiful Bill Act signed by President Donald Trump in July 2023, requires states to implement work, training, or education requirements for Medicaid recipients. The federal law applies to the 42 states (plus D.C.) that expanded Medicaid under the 2010 Affordable Care Act.

Simpson’s anxiety is compounded by past issues with government assistance. She lost food assistance after technical problems prevented her from renewing benefits on time. Now, she doubts the state’s ability to implement the new work rules smoothly.

"Adding more barriers won’t make the program work any better,"

Nebraska Medicaid’s Response to Work Requirements

Nebraska Medicaid officials assert they are streamlining the process to minimize administrative barriers that could lead to coverage loss. The state has outlined exemptions for enrollees with specific health conditions. Drew Gonshorowski, Nebraska’s Medicaid director, emphasized the state’s commitment to clarity in a news release issued in early April:

“Our top priority is making sure members clearly understand changes to the program and how to maintain their coverage.”

During an interview with KFF Health News on April 28 outside the National Press Club in Washington, D.C., Mehmet Oz, Administrator of the Centers for Medicare & Medicaid Services (CMS), expressed support for Nebraska’s initiative. Oz acknowledged ongoing challenges but remained optimistic:

“I applaud Nebraska for being the first state to begin implementing the work requirements. They’re still working out the kinks, but my hope is by the end of this year they will get into a more sophisticated place.”

Skepticism from Advocates and Health Industry Groups

Despite the state’s assurances, health policy analysts, advocates for low-income individuals, and health industry groups remain skeptical. They warn that thousands of Nebraskans could lose Medicaid coverage, jeopardizing access to essential health services and protection from medical debt. Jeremy Nordquist, President and CEO of the Nebraska Hospital Association, highlighted widespread concerns:

“There is a lot of concern on many different levels.”

Nordquist also noted that many enrollees may not even realize they must take action to maintain their coverage. The federal mandate, which takes effect in 2027, requires states to implement work requirements for adults with incomes up to 138% of the federal poverty level—equivalent to $22,025 for a single person in 2024.

The Nebraska Hospital Association further cautioned that an increase in uninsured patients could financially strain hospitals, exacerbating existing challenges in the healthcare system.