Nebraska Will Become First State With Medicaid Work Requirements

Nebraska will implement Medicaid work requirements starting May 1, 2026, requiring able-bodied adults aged 19-64 to complete 80 hours of work, community service, or educational activities each month to maintain their benefits:

https://nebraskapublicmedia.org/en/news/news-articles/nebraska-will-become-first-state-to-implement-medicaid-work-requirements/

Nebraska will become first state to implement Medicaid work requirements
By Macy Byars, Reporter Nebraska Public Media News
December 17, 2025

Gov. Jim Pillen and Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz announced Wednesday morning that Nebraska will be the first state to implement Medicaid work requirements passed in July’s “One Big Beautiful Bill," or H.R. 1.

The new work requirements require able-bodied adults aged 19-64 to log 80 hours a month of employment, education, work programming or community service to continue receiving Medicaid benefits.

Pillen said the work requirements will encourage able-bodied low-income Nebraskans to work and engage with their communities.

“This is a hand up, not a handout,” Pillen said. “It's a key piece of giving the discipline for our families to be successful. It's a key piece of self-worth. It's a key piece of mental health and stability.”

Oz – joining the conference via video call – applauded Pillen and Nebraska leadership for working quickly on the Medicaid work requirement provisions.

“What you're doing so boldly -- with this actually being the first state in the country to use this legislation as an opportunity to create community engagement -- is going to prevent generational poverty in Nebraska,” Oz said. “It's going to allow people to find pathways because we're going to make it easier for them to do the right thing when it comes to trying to find work.”

According to the 2024 Annual Medicaid Report from the Nebraska Department of Health and Human Services, about 360,000 Nebraskans were enrolled in Medicaid. Half were children, and 16% were blind, disabled or elderly.

Pillen said those groups will not be left behind. Some exemptions to work requirements are also provided for situations like pregnancy, severe illness and caregivers of disabled individuals.

“We're going to err on the side of people's welfare,” Pillen said. “It's our responsibility to take care of those less fortunate -- we’ll err on that. We're not out here to take everybody to the curb.”

Oz echoed Pillen’s remarks.

“We have to protect those populations,” Oz said. “When you bring able-bodied individuals into the system, you begin to change the dynamic -- the arrangement that we have amongst ourselves as a people.”

Pillen estimated that 30,000 Nebraskans will be put to work once work requirements are implemented.

Critics of work requirements worry they will add red tape for Medicaid recipients that depend on the program -- particularly individuals with disabilities.

Edison McDonald is the executive director of National Disability Action, an advocacy and policy group based in Hickman. In a statement given to Nebraska Public Media, McDonald said Nebraska’s eligibility system is already overwhelmed.

“I have worked closely with hundreds of families who rely on Medicaid and who want to work,” McDonald said. “I have also worked directly with Nebraska DHHS leadership to improve eligibility, access and opportunities for employment. The reality is simple. Nebraska’s Medicaid system is not prepared to implement this policy.”

Nebraska Appleseed Health Care Access Program Director Sarah Maresh call the quick rollout a “mistake,” and she said Nebraska should take time implementing new Medicaid provisions.

“We have seen in other states that when Medicaid work requirements are implemented too quickly, like what Nebraska is proposing here, thousands of people who are eligible for the program unnecessarily lose coverage and millions of state dollars are wasted on ineffective administrative costs,” Maresh said in a statement released Wednesday morning. “We know a vast majority of Nebraskans subject to these requirements work or meet an exemption to work requirements, but rushing to implement work requirements will cause them to lose coverage anyway.”

A Congressional Budget Office report from June estimated that Medicaid provisions in H.R. 1 will cause 4.8 million able-bodied adults subject to Medicaid work requirements would be without health care in 2034. Those losing health care due to citizenship and immigration status requirements are not included in that figure.

Maresh said Nebraska should take its time rolling out the implementation of H.R. 1 provisions to ensure eligible Nebraskans don’t lose health coverage.

Steve Corsi, CEO of Nebraska DHHS, said the agency is still working out the details of how work status will be tracked.

“We are currently looking at technology and existing resources and building a blueprint for that,” Corsi said. “CMS continues to make adjustments as we go along and remember that we have until May to tighten everything up. We're working with CMS closely, and we'll continue to do that as they figure out ways to manage the reporting.”

H.R. 1 allocates $200 million in implementation funding to the Centers for Medicare & Medicaid Services, which will distribute $2 million to each state in 2026. The other half of the funds will be distributed to states based on their Medicaid population sizes.

Pillen said no extra staff will be hired to track work requirements. Nebraska DHHS offices and the Department of Labor will work with CMS to implement requirements, recertify benefits and verify work status.

On top of current delays at DHHS, National Disability Action’s McDonald said having no new staffing will cause administrative failures that result in people unnecessarily losing health coverage.

“When people lose Medicaid, they do not become more employable,” McDonald said. “They become sicker, less stable and more likely to fall out of the workforce entirely. Nebraska should fix access and capacity problems before layering on policies that will push vulnerable people off care.”

According to Pillen, there are 100,000 jobs in Nebraska that need to be filled.

“There's incredible opportunities for every person who is wanting Medicaid that is able-bodied to work and will work really, really hard,” Pillen said.

Oz shared a national perspective.

“We believe there's twice as many jobs available in the country as people who apply to do them,” Oz said. “So, there actually is work to do. We just got to get it to people who are struggling to find their way with the job opportunities that can allow them to get back on their feet and get back into full employment.”

The Bureau of Labor Statistics October job report shows there are about 1.5 jobs per person in America.

Oz and Pillen said raising people above the poverty level so they no longer need to rely on Medicaid for health insurance coverage is a key goal of the work requirements. Both emphasized that more people entering the workforce will benefit the economy.

“What we're wanting to make sure we do is -- who's on Medicaid and not working and they're able-bodied -- we want to lift them up and help them understand and be a part of our economy,” Pillen said.

Pillen said there will be collaboration between agencies like the Department of Economic Development and Department of Labor to help Nebraskans search for employment and gain job skills.

Corsi said there are benefits to employment that can improve physical health, but also mental and emotional benefits that can increase overall well-being.

“In short, work requirements foster purpose, stability, resilience and long-term security for individuals, families and communities,” Corsi said.

Around 70,000 Nebraskans will be notified of the May 1 start date for work requirements via phone, text or email by Jan. 1.

Nebraskans seeking help with employment opportunities can visit the Department of Labor's NEworks website. Frequently asked questions about Medicaid work requirements and eligibility are available on the Nebraska DHHS website.