LINCOLN — Nebraska stepped Wednesday toward becoming the first state in the country to start its implementation of new federal work requirements for Medicaid health insurance recipients beginning May 1 of the new year.

Gov. Jim Pillen, joined on Zoom by Administrator of the Centers for Medicare and Medicaid Services Dr. Mehmet Oz and in person by state health officials, rolled out the state’s plans for the new federal requirement as a “hand up and not a hand out.”

“We’re not here to take everybody to the curb … [but] making sure we get every able-bodied Nebraskan to be part of our community,” Pillen said.

State health officials said the new requirements apply to work-eligible adults in the Medicaid expansion population aged 19 to 64. Those Medicaid recipients will be required to work at least 80 hours a month or be enrolled in school at least half-time to receive or keep health coverage.

Steve Corsi, Director of Nebraska’s Department of Health and Human services, said people will begin receive notice of the new requirements by Jan. 1, and the agency is working on details on how it will track work status.

Nebraska voters opted into Medicaid expansion in 2018, and the expansion was implemented in 2020. Thus far, 40 states and Washington, D.C., have opted into the expansion allowed under former President Barack Obama’s 2010 overhaul of health insurance, the Affordable Care Act.

The new work requirements come from Trump’s tax and spending bill that passed Congress this year, the bill President Donald Trump calls “big and beautiful.” New requirements for Medicaid and other social safety net programs are meant to offset the cost of Trump’s domestic agenda, which includes increased spending on immigration enforcement, funding for the “Golden Dome” missile defense program, cementing tax cuts that primarily benefit high earners and adding temporary tax breaks for workers earning less.

Some Congressional Republicans have said the requirements would eliminate what they describe as “waste, fraud and abuse” in the system by requiring more verification of people’s eligibility for the benefits.

Nebraska health care advocates who opposed the work requirements called it a mistake for the state to implement the changes first. Nebraska Appleseed Health Care Access Program Director Sarah Maresh said, “thousands of people who are eligible for the program [will] unnecessarily lose coverage.”

“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,” Maresh said.

When asked how many people are expected to lose Medicaid due to the new work requirement, Pillen said the state expects about 30,000 people to be “lifted up” or moved onto work-related health insurance and off of the federal and state Medicaid program.

The governor also said it wouldn’t cost the state more to monitor and enforce the requirements. Pillen and Dr. Oz framed the requirements as a way to “prevent generational poverty in Nebraska.”

Edison McDonald, executive director of National Disability Action, an advocacy and policy group based in Hickman, said, “Nebraska’s Medicaid system is not prepared,” and any claim that the changes will be implemented smoothly is “not credible.”

“Nebraska should fix access and capacity problems before layering on policies that will push vulnerable people off care,” McDonald said.

About 360,000 Nebraskans were enrolled in Medicaid by the end of 2024. Half were children, and 16% were blind, disabled or elderly, according to the 2024 Annual Medicaid Report.

This story was published by Nebraska Examiner, an editorially independent newsroom providing a hard-hitting, daily flow of news. Read the original article: https://nebraskaexaminer.com/2025/12/17/nebraska-becomes-first-state-to-...