Nebraska will be the first state to implement new federal Medicaid work requirements on May 1, potentially affecting about 30,000 expansion enrollees. Expansion beneficiaries ages 19–64 must work 80 hours per month, perform community service, or be enrolled at least half-time in school, and must report compliance every six months or risk losing coverage. The CBO projects $326 billion in federal Medicaid savings over 10 years but anticipates about 4.5 million people will become uninsured annually beginning in 2027. Past state efforts in Georgia and Arkansas led to substantial coverage drops and underscore potential administrative and coverage risks.
Nebraska To Enforce New Federal Medicaid Work Rules — May 1 Start Could Affect Tens Of Thousands
FILE - Nebraska Gov. Jim Pillen greets state senators before giving a speech on June 2, 2025, in Lincoln, Neb. (Justin Wan/Lincoln Journal Star via AP, File)(ASSOCIATED PRESS)
Nebraska plans to become the first state to put into effect new federal work requirements for a segment of Medicaid recipients, Gov. Jim Pillen announced. The rule is scheduled to take effect on May 1 and could affect roughly 30,000 people who receive Medicaid through the program's higher-income expansion category.
What The Rule Requires
Under the federal law signed last year, people ages 19 to 64 who are covered through the Medicaid expansion must either work or perform community service at least 80 hours per month, or be enrolled in school at least half-time, to retain their coverage. All expansion-eligible beneficiaries will also be required to submit documentation every six months proving they meet the requirement; failure to report will result in loss of benefits.
Who Is Covered And Who Is Exempt
The requirement applies only to those enrolled under Medicaid expansion, which extends eligibility to people with somewhat higher incomes. Of 346,000 Nebraskans enrolled in Medicaid as of May, about 72,000 were enrolled through the expansion group; state officials estimate roughly 30,000 expansion enrollees could be affected by the new rule.
Exemptions include disabled veterans, pregnant people, parents or guardians of dependent children under 14 (or of disabled dependents), those recently released from incarceration, people experiencing homelessness, and those receiving addiction treatment. States may also offer temporary hardship exemptions for others.
FILE - Centers for Medicare & Medicaid Services administrator Dr. Mehmet Oz listens as President Donald Trump speaks in the Oval Office of the White House, Oct. 16, 2025, in Washington. (AP Photo/Alex Brandon, File)(ASSOCIATED PRESS)
Administrative Impact
The six-month reporting cadence is twice as frequent as reporting for many other Medicaid enrollees, increasing paperwork and administrative work for state agencies. Implementing the change may require costly updates to computer systems and enrollment platforms. Gov. Pillen said he does not expect to expand state staffing to administer the policy.
Projected Effects And Context
The nonpartisan Congressional Budget Office estimates the federal requirement could reduce Medicaid spending by about $326 billion over 10 years and projects roughly 4.5 million people would be uninsured each year beginning in 2027 as a result of the rule. Analysts note that because many Medicaid recipients who are able to work already do so, the policy is not expected to substantially increase overall employment.
Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, joined Pillen’s announcement by video, saying the administration believes jobs exist nationwide and that the challenge is connecting people to employment opportunities.
Lessons From Other States
Georgia implemented similar work and reporting requirements in 2023 and enrolled far fewer people than projected, a shortfall partly attributed to the new rules. Arkansas enacted a version of work requirements in 2018 that a judge later blocked; that program removed about 18,000 people from coverage in its first seven months before being halted.
Bottom line: Nebraska’s move will test how work requirements, more frequent reporting, and administrative capacity interact — and it may lead to significant coverage losses even if employment does not rise materially.
