Medicaid Work Requirements Begin in Nebraska, With National Rollout to Follow
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A new federal law requires many Medicaid enrollees to prove they are working, training, or in school to maintain coverage. Nebraska becomes the first state to implement the requirement this week, with most other expansion states required to follow by 2027. Officials estimate the change will leave millions uninsured over the next decade.
Facts First
- Nebraska implements Medicaid work requirements starting May 1, affecting an estimated 70,000 enrollees.
- Enrollees must work, volunteer, or attend school at least 80 hours monthly to keep coverage, with exemptions for caregivers and certain health conditions.
- 42 states and D.C. must implement similar requirements by 2027 under the new federal law.
- The Congressional Budget Office estimates 4.8 million people will become uninsured over the next decade due to the requirement.
- Nebraska officials say about 72% of affected enrollees likely won't need to act as their status is already known via databases.
What Happened
President Donald Trump and Republican members of Congress signed a tax cut and spending bill on July 4, 2025, known as the One Big Beautiful Bill Act. The law mandates that certain Medicaid enrollees work, train, or go to school. Nebraska will become the first state to implement these Medicaid work requirements starting Friday, May 1. Under the law, enrollees must work or volunteer at least 80 hours a month, attend school at least part-time, or participate in job training to maintain coverage. The bill requires the 42 states and the District of Columbia that fully or partially expanded Medicaid under the 2010 Affordable Care Act to implement work requirements starting in 2027.
Why this Matters to You
If you or someone you know receives Medicaid coverage through the expansion program, your continued eligibility may now depend on proving you meet work or activity requirements. You will need to document that you work, volunteer, attend school, or qualify for an exemption. In Nebraska, officials plan to use existing data sources like Medicaid claims and credit agency information to verify compliance for many, which could simplify the process for some. The law also reduces retroactive eligibility for expansion enrollees from three months to one month, meaning you may have a shorter window to apply for coverage for past medical bills. A study in the Annals of Internal Medicine found that approximately one-third of adults at risk of losing coverage under the new requirement reported having a physical or mental illness or disability, suggesting the requirement may disproportionately affect people with health challenges.
What's Next
Montana plans to launch its work requirement in July, and Iowa plans to launch in December. Other states that expanded Medicaid under the Affordable Care Act will need to develop and implement their own programs by 2027. The Congressional Budget Office (CBO) estimates 4.8 million people will become uninsured over the next decade due to the work requirement. In Nebraska, state officials will allow enrollees to self-attest to volunteering, schooling, or exemptions without requiring medical records, which may help streamline the process for those who need to report.