Nebraska becomes first U.S. state to enact Medicaid work requirements

Key Points:

• Nebraska became the first U.S. state to implement Medicaid work requirements, applying to about 70,000 expansion enrollees who must work, perform community service, or attend school for at least 80 hours a month, with exemptions for certain groups.
• Experts warn the new rules may lead to significant coverage losses, with the Urban Institute estimating up to 25,000 Nebraskans (36% of those subject) could lose Medicaid, often due to paperwork issues rather than failure to meet requirements.
• Other states, including Iowa, Montana, and Nebraska, plan to implement similar work requirements by the end of 2026, but many questions remain about implementation details, such as defining "medically frail" exemptions and managing exemptions for travel to care.
• Past experiences in Arkansas and Georgia showed that Medicaid work requirements did not increase employment but resulted in substantial coverage losses and increased barriers to care, leading some experts to question the effectiveness of such policies.
• Nebraska officials and federal CMS leaders praise the policy as promoting independence and self-sufficiency, while critics caution that rapid implementation has caused confusion and may reduce access to healthcare for vulnerable populations.