Nebraska Leads Nation in Enacting Medicaid Work Rules, Putting Tens of Thousands at Risk

Nebraska implemented the Medicaid work requirement on Friday, becoming the first state to do so under the federal tax and spending bill passed last summer. The rule applies to able‑bodied recipients aged 19 to 64 without dependents, requiring them to work, volunteer, or attend school for at least 80 hours each month. Exemptions exist for parents of young children and people with disabilities.

The state’s analysis estimates that 28,000 to 41,000 Nebraskans could lose Medicaid coverage by 2034 because of the new requirement. Nationally, the Congressional Budget Office projects that roughly 5.2 million people might lose coverage by the same year. Health policy expert Sara Rosenbaum warned that the change would create a public health and economic catastrophe, noting that untreated chronic conditions could rise among low‑income residents.

Supporters argue the rule encourages employment and reduces waste, while critics say it adds bureaucratic hurdles that could jeopardize care for those already working or studying. The policy also introduces six‑month eligibility redeterminations and stricter income verification, increasing administrative burden. What to watch next: state enrollment data and health impact reports through 2026 to see if coverage losses match projections.