Nebraska became the first state to enforce Medicaid work requirements under federal law, launching the program on May 1. Under the new rules, approximately 70,000 adult Medicaid recipients in the state must demonstrate they are working or engaged in similar activities for 80 hours per month, or qualify for an exemption.
Eli McCreary, a 64-year-old Omaha resident recently diagnosed with kidney cancer, reported losing his Medicaid coverage after being informed he had not satisfied the work requirement. McCreary, who manages multiple chronic conditions including diabetes and chronic obstructive pulmonary disease, stated he was unable to secure employment given his health limitations. He subsequently canceled medical appointments and diagnostic tests related to his cancer diagnosis.
State officials characterized the rollout as successful, citing data indicating 86% of affected applicants met the requirement or qualified for an exemption, with 93% of existing enrollees retaining coverage. However, health clinics and advocacy organizations reported implementation problems stemming from insufficient training and staffing shortages. State officials acknowledged the May 1 deadline presented logistical challenges.
Nebraska allocated $8.2 million over two years to contractors assisting with the program’s implementation, including Boston-based Public Consulting Group and Atlanta-based Covendis. State documents obtained through public records requests identified contractor costs exceeding $250,000 each, with one consultant’s compensation exceeding $1.8 million. The state opted not to increase permanent workforce to manage the program, instead relying on private contractors. Advocates expressed concerns about confused enrollees receiving inaccurate information regarding eligibility and requirements.
Democrats have indicated plans to attempt repealing the Medicaid changes during their first 100 hours in office in January, though the outcome remains uncertain given potential presidential veto authority.
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