Nebraska Becomes First State to Implement Medicaid Work Requirements

Nebraska became the first state to implement Medicaid work requirements as of May 4, 2026, mandating able-bodied adults engage in specified hours of work or community service monthly to maintain coverage. Tens of thousands of residents could lose coverage if they fail to meet requirements or struggle with reporting. Many previous work requirement attempts during the Trump administration were blocked by federal courts or stalled by the Biden administration.

Nebraska work requirement implementation

• ▪Republican-led states are watching Nebraska's Medicaid work requirement implementation to determine if it provides a blueprint for a national shift in Medicaid administration.
• ▪Tens of thousands of Nebraska residents could potentially lose Medicaid coverage if they fail to meet the new work requirement mandates or struggle with the reporting process.
• ▪Nebraska became the first state to formally implement Medicaid work requirements as of May 4, 2026.
• ▪Nebraska's Medicaid work requirements target able-bodied adults who do not have a documented disability or are not primary caregivers.
• ▪Nebraska's Medicaid work requirements mandate that eligible adults engage in a specified number of hours of work or community service per month to remain eligible for Medicaid.

Administrative burden coverage loss

• ▪Procedural disenrollment from Medicaid work requirements often results in loss of coverage for eligible people rather than a reduction in the rolls of the ineligible.
• ▪Nebraska must build or adapt infrastructure capable of verifying employment in real-time for thousands of individuals to implement Medicaid work requirements.
• ▪Single parents, those in rural areas with limited transportation, and individuals with fluctuating health conditions are most likely to struggle with rigid Medicaid work requirements.
• ▪Many people who were actually working lost Medicaid coverage in previous state work requirement attempts because they could not navigate complex reporting systems or lacked technology to submit proof of employment.

Fiscal rationale work incentives

• ▪The cost of administering Medicaid work-verification systems can reduce the savings gained from reduced enrollment, according to some economists.
• ▪States implementing Medicaid work requirements aim to reduce the total number of enrollees to lower the state's share of Medicaid spending.
• ▪Medicaid work requirements are based on the belief that government assistance should be a temporary bridge to self-sufficiency rather than a permanent safety net.

Federal legal challenges

• ▪The Trump administration encouraged states to adopt Medicaid work requirement mandates.
• ▪Legal challenges to Medicaid work requirements typically center on whether the requirements violate the Social Security Act or constitute an unreasonable barrier to a federally mandated benefit.
• ▪The Centers for Medicare & Medicaid Services under the Obama and Biden administrations often denied state Medicaid work requirement waivers on the grounds that requirements were too restrictive or states lacked viable plans to prevent mass loss of coverage.
• ▪Many Medicaid work requirement attempts during the Trump administration were blocked by federal courts or stalled by the Biden administration.

Beneficiary reporting requirements impact

• ▪When Medicaid insurance is lost due to work requirements, preventative care such as annual checkups, medication refills, and screenings is often the first thing to go.
• ▪Medicaid work requirement reporting processes require a level of digital literacy and consistent internet access that is not universal among the lowest-income populations.
• ▪Medicaid beneficiaries in states implementing work requirements are typically required to log into a state portal and report their work hours monthly.
• ▪The first full quarterly review of Nebraska's Medicaid enrollment data will be a critical checkpoint for assessing the work requirement program.

Perspective of Critics of Medicaid work requirements

• ▪Many people who were actually working lost Medicaid coverage in previous state work requirement attempts because they could not navigate complex reporting systems or lacked technology to submit proof of employment.
• ▪Procedural disenrollment from Medicaid work requirements often results in loss of coverage for eligible people rather than a reduction in the rolls of the ineligible.

Perspective of Republican-led states

• ▪Republican-led states are watching Nebraska's Medicaid work requirement implementation to determine if it provides a blueprint for a national shift in Medicaid administration.
• ▪The Trump administration encouraged states to adopt Medicaid work requirement mandates.

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