Nebraska is pioneering the implementation of work requirements for Medicaid, the first state to enact this feature following President Trump’s 2025 budget law. On Saturday, the state will begin removing individuals who fail to meet these new criteria from Medicaid coverage.
Drew Gonshorowski, Nebraska’s Medicaid Director, highlighted that around 200 Nebraskans will lose their Medicaid benefits as of August 1. Gonshorowski stated, “We’ve ensured that we have extra steps in place making sure we review any denial multiple times before it goes out the door. We don’t want folks falling through the cracks on this.”
Under new federal guidelines, approximately 20 million individuals across 44 states must engage in employment, volunteer activities for 80 hours monthly, attend school, or undergo job training to maintain their Medicaid benefits. Exemptions exist for certain groups, such as individuals with disabilities or serious illnesses, parents of young children, and caregivers.
The work requirements stem from Trump’s fiscal legislation enacted last year and are to be implemented by January 1. Nebraska chose an early rollout, believing these rules foster economic stability. “It is an opportunity to build something that can reach out a hand to our membership,” Gonshorowski noted.
Supporters assert the policy aids in reducing poverty and forecasts federal savings of $325 billion over a decade. However, opponents cite research showing similar past policies failed in job creation and affected many who were unaware of or hindered by paperwork.
Projections estimate between 3 million and 8.6 million individuals nationwide could lose coverage due to new requirements by 2028, including around 30,000 Nebraskans.
In a discussion with Tradeoffs, Gonshorowski emphasized Nebraska’s readiness, citing its independently operated eligibility system. He assured that three-quarters of those required to work can have their compliance verified without personal contact. “I can get on the system, I can make a little request and … without reaching out to the member, we can confirm that they’re compliant with work requirements,” he said.
Nebraska has notified residents through letters, texts, emails, and broadcasts about the new conditions. Despite efforts, advocates, such as Amy Behnke from the Health Center Association of Nebraska, criticized the clarity of the notices, causing confusion among low-income populations.
Tradeoffs experienced issues with Nebraska’s Medicaid help line, encountering extensive wait times and call disruptions, including challenges accessing the Spanish-language line. Officials report an average wait of 10 minutes, with Gonshorowski regularly meeting with federal representatives to refine outreach.
As coverage terminations occur, Gonshorowski anticipates monitoring appeals and Medicaid fair hearings closely. “I view this as the ultimate bellwether on whether or not you got your process right on implementation,” he remarked.
Gonshorowski shared concerns over accurately identifying disabilities or earned income statuses, emphasizing, “That is the one scary number.”
Efforts to assist individuals losing coverage involve collaboration with the state labor department, aiming to connect them with job opportunities using new data streams. “I think that amidst all this controversy, one of those great opportunities in this implementation is for states to use that data for good, too,” Gonshorowski concluded.