Medicaid Work Requirements: Nebraska Offers a Troubling Preview

Omaha, Nebraska (Photo: John Matychuk via Unsplash)

Republican lawmakers claimed that changes to Medicaid work rules contained within President Donald Trump’s so-called One Big Beautiful Bill Act, wouldn’t impact citizens’ existing coverage. Early results show otherwise. While most states will enforce the new rules beginning in January 2027, Nebraska launched them on May 1, 2026.

Soon after, Eli McCreary, then 64, was told by his local hospital in Omaha that he had lost coverage for failing to meet the bill’s monthly work requirements and would have his upcoming appointments canceled unless he paid out-of-pocket. Noting that he had heard of the new work rules, McCreary told KFF Health News that he didn’t realize they might apply to him. He was just a few months removed from substance use treatment and was navigating diabetes, chronic obstructive pulmonary disease and a new kidney cancer diagnosis. “I don’t understand what job I can get,” he said. “I can’t walk. I can hardly breathe. I can’t move around. What job am I going to get?”

McCreary was forced to cancel a CT scan and other tests, including a cancer-related appointment with a doctor who travels back and forth to Omaha every month. “I missed my window of opportunity with him for another month,” he said, recalling the despair he felt from the ordeal. Though he was eventually able to reschedule, the cancer had grown significantly by the time he had his right kidney removed in early November.

Attorneys and policy experts working with Medicaid enrollees added that McCreary should have never been in that position because the law exempts people with serious medical conditions or substance use disorders. But Nebraska health officials say their records show McCreary experienced “no lapses in coverage.” He received Medicaid through the Affordable Care Act expansion, and people covered under that expansion were subject to work rules under the new law. But officials claimed that he actually aged out of Medicaid and into Medicare at age 65 before the new requirement could apply to him. Still, many people are confused about which rules apply to them – McCreary, who was a driver for an asphalt services company before his health deteriorated, said he may have missed letters notifying him of the shift.

Nebraska health officials claim that the rollout of changes to Medicaid “has been very successful,” pointing to state data showing that 93% of existing enrollees kept their coverage. But groups that serve Nebraska’s low-income and working families say that the rollout has been full of missteps, largely tied to poor training of an overburdened staff. Amid the state’s refusal to hire additional workers to support the rule changes, average Medicaid call center wait times doubled between May and July, leaving some callers on hold for hours. People who work “just don’t have time to be sitting on the phone,” said Kenny McMorris, who runs the Charles Drew Health Center in North Omaha.

By August, roughly 1,100 Nebraskans had been denied benefits due to the work requirements, mostly for not responding to information requests. Nebraska’s total Medicaid enrollment has also fallen by about 4,600 people since May, a reduction of 1.4%.

Nebraska’s experience may offer a preview of what’s coming in the rest of the country. Next year, work requirements will reach millions of Medicaid enrollees in more than 40 states. The Congressional Budget Office has estimated that the policy will leave 5.3 million people uninsured by 2034. Democrats, who will take control of Congress in January, have pledged to repeal the Medicaid changes within their first 100 hours, though President Trump could veto the effort.