Nebraska Leads Early Rollout of Federal Medicaid Work Requirements

On Aug. 1, Nebraska will begin enforcing the new federal Medicaid work-requirement rule, removing roughly 200 Nebraskans from coverage.

NPR

The requirements stem from the “One Big, Beautiful Bill Act,” signed by President Donald J. Trump last July. Adults aged 19-64 in 44 states must work, volunteer, or complete job training for at least 80 hours each month to keep Medicaid benefits. Exemptions include documented disabilities, pregnant women, caregivers of children under 14, and those deemed “medically frail.” CMS set a compliance deadline of Jan. 1, 2027 for the 40 Medicaid-expansion states and Washington, D.C.

CNBCDHS: 63K Medicaid members lack documentation to meet federal work requirements next year NPR

• Nebraska’s eligibility system covers about 70,000 people subject to the rule; an estimate of 30,000 could lose coverage by 2028.

NPR

• Federal guidance projects 20 million people in 44 states will face the 80-hour requirement.

NPR

• Wisconsin estimates 200,000 BadgerCare participants will be subject, with 63,000 lacking documented work history.

DHS: 63K Medicaid members lack documentation to meet federal work requirements next year

• KFF finds the average Medicaid spend per disabled individual is roughly $21,000 per year.

CNBC

Nebraska officials emphasize a “hands-on” approach and say the agency monitors appeals as a “bellwether” for implementation success. Medicaid Director Amanda Dreyer noted the state is defining “medical frailty” while awaiting further CMS guidance.

DHS: 63K Medicaid members lack documentation to meet federal work requirements next year

Advocates such as Amy Behnke of the Health Center Association of Nebraska argue that outreach—letters, texts, ads—has been confusing, leaving low-income residents uncertain about eligibility. Rare-disease groups say the exemption language for “medically frail” is vague and could be applied inconsistently. Wisconsin Democrats and liberal groups have called the rule “red tape” that threatens lifesaving care.

DHS: 63K Medicaid members lack documentation to meet federal work requirements next year

Rebecca Reed, a Wisconsin Medicaid recipient who completed breast-cancer treatment, expressed anxiety about maintaining coverage after treatment ends, fearing loss of medication and rehabilitation benefits. Rare-disease patients report similar concerns, noting that disease flares or clinical-trial travel could temporarily prevent meeting the 80-hour threshold.

DHS: 63K Medicaid members lack documentation to meet federal work requirements next year

Estimates of nationwide coverage loss vary from 3 million to 8.6 million people by 2028. The definition of “medically frail” remains unsettled, with states like Wisconsin crafting interim criteria while awaiting CMS clarification.

DHS: 63K Medicaid members lack documentation to meet federal work requirements next year

• “I can get on the system, I can make a little request and … without reaching out to the member, we can confirm that they're compliant with work requirements,” — Drew Gonshorowski, Nebraska Medicaid director

NPR

• “Now, Republicans are pushing forward even more red tape for families,” — Tammy Baldwin, U.S. senator

DHS: 63K Medicaid members lack documentation to meet federal work requirements next year

CMS’s public-comment period on the work-requirement rule closes this week. Nebraska will track appeal rates after Aug. 1, while Wisconsin plans to begin notifying current Medicaid members of the upcoming requirements in August. Both states say they will adjust outreach and verification processes as CMS issues further guidance.

DHS: 63K Medicaid members lack documentation to meet federal work requirements next year