Nebraska on Friday became the first U.S. state to enforce Medicaid work requirements, seven months ahead of the federal deadline set by the Republican-backed 'One Big Beautiful Bill Act.' The new rules apply to about 70,000 Medicaid expansion enrollees aged 19 to 64, requiring them to work, train, or attend school for at least 80 hours per month to maintain coverage. Exemptions include pregnant women, caregivers, and individuals with medical conditions.
Immediate Impact and Concerns
The Urban Institute estimates that up to 25,000 Nebraskans, or 36% of those subject to the requirements, could lose coverage, primarily due to administrative hurdles or failure to prove exemptions. State officials emphasize efforts to simplify compliance, while critics warn of increased barriers to healthcare access.
Policy Rationale and Opposition
Supporters, including House Speaker Mike Johnson, argue the requirements reduce 'fraud, waste, and abuse' in Medicaid. The Centers for Medicare & Medicaid Services (CMS) Administrator Mehmet Oz has expressed confidence in the rollout. However, advocates like Schmeeka Simpson, a Medicaid recipient working three jobs, fear bureaucratic errors could lead to coverage loss.
Broader Implications
Three other states—Montana, Iowa, and Nebraska—plan to implement similar requirements by year-end. Health policy experts are closely monitoring Nebraska's rollout to assess potential nationwide effects, with estimates suggesting up to 10 million Americans could lose coverage under such policies.