Nebraska plans to be the first state to implement Trump's new Medicaid
work requirements
[December 18, 2025]
By GEOFF MULVIHILL
Nebraska will become the first state to implement new work requirements
for some people with Medicaid health insurance under a law President
Donald Trump signed last year.
Gov. Jim Pillen, a Republican, announced Wednesday that the requirement
would take effect in the state May 1 and could impact about 30,000
people who have slightly higher incomes than traditional Medicaid
beneficiaries.
“We’re not here to take everybody to the curb,” he said. Instead, he
said, the aim is “making sure we get every able-bodied Nebraskan to be
part of our community.”
The sweeping tax and policy law Trump signed in July requires states to
make sure many recipients are working by 2027 but gave them the option
to do it sooner.
Beneficiaries will have more reporting duties
The law mandates that people ages 19 to 64 who have Medicaid coverage
work or perform community service at least 80 hours a month or be
enrolled in school at least half-time to receive and keep coverage.
It applies only to people who receive Medicaid coverage through an
expansion that covers a population with a slightly higher income limit.
Forty states and the District of Columbia have opted to expand the
coverage income guidelines under former President Barrack Obama's 2010
health insurance overhaul.
Of 346,000 Nebraska residents enrolled in Medicaid as of May, about
72,000 were in the higher income expansion group.
Some people will be exempted, including disabled veterans, pregnant
women, parents and guardians of dependent children under 14 or disabled
individuals, people who were recently released from incarceration, those
who are homeless and people getting addiction treatment. States can also
offer short-term hardships for others if they choose.
All Medicaid beneficiaries who are eligible because of the expansion
will be required to submit paperwork at least every six months showing
they meet the mandate.
Those who don't would lose their coverage.
The reporting requirement is twice as frequent as it is for most people
covered by Medicaid now. That change means more work for the state
agencies — and for some of them, extensive and likely expensive computer
program updates.
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Nebraska Gov. Jim Pillen greets state senators before giving a
speech on June 2, 2025, in Lincoln, Neb. (Justin Wan/Lincoln Journal
Star via AP, File)
Pillen said he does not expect the
state government to increase staffing to make the changes.
When and how to implement the change is likely to be on the agenda
for governors and state lawmakers across the country as legislative
sessions start — most of them in January.
The policy is expected to lead to lost coverage
The nonpartisan Congressional Budget Office estimates that the
requirement will reduce Medicaid costs by $326 billion over a decade
— and that it will result in 4.5 million people becoming uninsured
each year starting in 2027. Currently, about 77 million Americans
are covered by Medicaid.
Because most people covered by Medicaid who are able to work already
do, it's not expected to increase employment rates.
Mehmet Oz, the administrator of the Centers of Medicare and Medicaid
Services, joined Pillen's announcement via a video feed and said the
administration believes there are jobs available across the country,
and the challenge is connecting people with them.
“Most people who are able-bodied on Medicaid actually want to get a
job,” Oz said.
Georgia implemented similar requirements in 2023. Far fewer people
are covered than projected, in part because of the work and
reporting requirements.
Arkansas tried another variation of Medicaid work requirements —
later blocked by a judge — that saw 18,000 people kicked off
coverage in the first seven months after it took effect in 2018.
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