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Nebraska Becomes First State to Enforce Medicaid Work Rules Early

The early rollout will serve as a test case for other states ahead of federal guidance in June.

Overview

  • Starting Friday, Nebraska will require many expansion enrollees ages 19 to 64 to show 80 hours of work, volunteering or school each month, or $580 in earnings.
  • State officials say about 72,000 people are covered under expansion, with roughly 25,000 subject to the new checks and 3,000 to 4,000 new applicants each month facing a 30‑day response window.
  • Eligibility will move to six‑month renewals, and the state will try to confirm jobs or exemptions through data matches, counting one compliant month in the past year for now.
  • Beneficiaries describe high stakes, and advocates cite confusion over a new 295‑page medically frail list and what qualifies for exemptions, warning eligible people could lose care.
  • An Urban Institute analysis projects similar policies could result in 5 million to 10 million fewer people enrolled in Medicaid nationwide, a backdrop as other states watch Nebraska’s approach.