Nebraska becomes first state to pursue Medicaid work requirements
LINCOLN, Neb. (KLKN) — Gov. Jim Pillen on Wednesday announced Nebraska as the first state to pursue Medicaid work requirements.
Dr. Mehmet Oz, the administrator of the Centers for Medicare & Medicaid Services, joined Pillen at the Nebraska State Capitol building to make the announcement.
During the conference, Pillen detailed Nebraska’s intent to implement the requirements by May 1, 2026.
The new work requirements are mandated by the One Big Beautiful Bill Act, which President Donald Trump signed in July.
“We, the incredible people and state of Nebraska, are the first state in the nation to begin implementing work requirements that are passed in the Big Beautiful Bill,” Gov. Pillen said.
Under the new rules, able-bodied adults ages 19-64 in the Medicaid expansion population will be required to participate in work, approved work programs, community service or educational activities for at least 80 hours per month, unless they qualify for an exemption.
Pillen said the new policy will promote long-term independence and stronger community ties.
“These requirements will help Nebraskans achieve greater self-sufficiency through employment and other meaningful activities,” Pillen said. “Working not only provides purpose but also helps people become active, productive members of their communities. Nebraska will be ready to move forward with these requirements before the federally mandated start of Jan. 1, 2027.”
Oz said Nebraska is leading the way during this transformation.
“Across the nation, our goal is to support people engaged in meaningful work, involved in their communities, and connected to the support that sets them up for long-term success,” Oz said. “We congratulate Governor Pillen and his team for their commitment to helping more Nebraskans move toward greater independence and opportunity.”
Nebraska Department of Health and Human Services CEO Dave Corsi said these changes will help Nebraska’s businesses and economy.
“Employment provides financial stability, fosters personal growth, and will help Nebraska’s small businesses in need of workers,” said Corsi. “These new requirements move Nebraska forward by encouraging greater economic and social participation.”
Current Nebraska Medicaid members will be assessed for the new requirements during their regularly scheduled renewal after the implementation date.
Individuals applying for Medicaid on or after May 1, 2026, must verify their community engagement activities or a qualifying exemption.
The work requirements apply to Medicaid expansion enrollees with an income up to 138% of the federal poverty level.
In 2025, the thresholds are $21,610 for a single person and $44,380 for a family of four.
Nebraska Medicaid will use available data to verify compliance during application and renewal.
If verification cannot be completed, members will be responsible for submitting documentation. Individuals found non-compliant will receive notice and have 30 days to meet the requirement or claim an exemption; otherwise, they will be denied or disenrolled.
Specific individuals are excluded from these requirements, including:
- People who are disabled
- People who are currently in foster care
- People aged 25 and under who aged out of foster care
- Members of recognized Native American tribes
- Pregnant women
- Parents or guardians of children up to age 13
- Caregiver of an individual with disabilities
- Disabled veterans (with a ‘total’ disability status)
- Medically frail people
- People who are compliant with work requirements under the SNAP or TANF programs
- People receiving treatment for a substance use disorder
- People who are incarcerated or have been within the last 90 days
- People who qualify for Medicare Part A or B
Some organizations are raising the alarm following the announcement.
Nebraska Appleseed’s Health Care Access Program Director Sarah Maresh released a statement, saying:
“This is a mistake. We have seen in other states that when Medicaid work requirements are implemented too quickly, like what Nebraska is proposing here, thousands of people who are eligible for the program unnecessarily lose coverage and millions of state dollars are wasted on ineffective administrative costs.
We know a vast majority of Nebraskans subject to these requirements work or meet an exemption to work requirements, but rushing to implement work requirements will cause them to lose coverage anyway. The fact that the Governor is already estimating that 30,000 people will lose their coverage proves that our state is not prepared or ready for the task ahead of them.
Our state should take its time to implement the requirements set by H.R.1 to ensure that all eligible Nebraskans maintain the health care coverage they need.”
DHHS will send a notice by mail, email or text to beneficiaries who must participate in community engagement (or have an exemption). More information on the requirement is available here.
