By Alli Peck, North Platte Post / Sandhills Post
LINCOLN — Nebraska has taken a first-in-the-nation step toward requiring work or community engagement as a condition of Medicaid coverage for able-bodied adults, Gov. Jim Pillen announced Wednesday. The governor was joined by Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services (CMS), along with senior state health officials for the announcement at the Nebraska State Capitol.
Under the plan, Nebraska will pursue implementation of work requirements for Medicaid expansion members beginning May 1, 2026, months ahead of the federal deadline. Pillen signed a letter of intent to CMS outlining the state’s timeline and strategy.
“This policy will help Nebraskans achieve greater self-sufficiency through employment and other meaningful activities,” Pillen said, describing the program as a way to build stronger community ties and promote long-term independence.
What the Requirements Entail
Beginning next spring, able-bodied Medicaid enrollees ages 19–64 who are part of Nebraska’s Medicaid expansion population must complete at least 80 hours per month of qualifying activities to maintain their coverage, unless exempt. Qualifying activities include:
- Employment
- Attendance in school or apprenticeship programs
- Participation in approved work programs
- Volunteering in the community
State officials estimate that roughly 30,000 Nebraskans could be subject to the new requirements.
CMS Administrator Dr. Oz said Nebraska’s move marks a national milestone. “Nebraska is leading the way … and we congratulate Governor Pillen and his team for their commitment to helping more Nebraskans move toward greater independence and opportunity,” he said. Federal officials plan to work with Nebraska and other states to ensure the program is implemented smoothly and in compliance with federal law.
Exemptions and Support
The plan includes a range of exemptions for populations that federal and state officials said should not be subject to the requirement. Exempt groups include:
- People who are disabled or medically frail
- Individuals currently in or under age 26 who have aged out of foster care
- Members of recognized Native American tribes
- Pregnant women
- Parents or guardians of children up to age 13
- Caregivers of people with disabilities
- Disabled veterans
- Those compliant with work requirements under SNAP or TANF
- People receiving substance use treatment
- People incarcerated within the last 90 days
- Individuals eligible for Medicare Part A or B
Officials also highlighted resources available through the Nebraska Department of Labor’s NEworks job service for beneficiaries seeking employment support.
Next Steps for Nebraska Medicaid Members
Current Medicaid expansion members in Nebraska will be assessed for compliance with the new requirements at their next regularly scheduled renewal after the May 1 implementation date. New applicants on or after that date will need to verify participation in qualifying activities or demonstrate an exemption when applying.
State Department of Health and Human Services officials said notices will go out by mail, email, or text to beneficiaries who must participate in community engagement or qualify for exemptions, and more detailed information will be available on the DHHS website.
What It Means Locally
Supporters of work requirements say the policy encourages employment and community involvement and can strengthen economic stability for individuals and families. Opponents in other states where similar policies have been introduced have raised concerns about coverage loss and administrative challenges, though state officials say Nebraska’s plan includes safeguards and exemptions.