Public Health — News & Analysis

Nebraska becomes first state to disenroll Medicaid recipients under new work requirements (July 31, 2026)

LINCOLN, Neb., July 31, 2026 — Nebraska begins removing Medicaid recipients from coverage on Saturday, becoming the first state in the country to disenroll anyone under the work requirements created by the One Big Beautiful Bill Act. Noelle Annonen reports for Nebraska Public Media from a panel convened Friday morning by the advocacy group Nebraska Appleseed.

Gov. Jim Pillen brought the requirements into force on May 1, eight months ahead of the federal deadline, saying he moved early to reduce the program's size and cost and describing Nebraska as a model for other states. Enrollees aged 19 to 64 who are not pregnant, have no disability, meet citizenship or immigration rules, and earn under 138% of the federal poverty level must log at least 80 hours a month of work, work program attendance, volunteering, or schoolwork. State DHHS puts that income ceiling at roughly $22,000 a year for one person and $45,500 for a family of four.

State Medicaid and Long-Term Care Director Drew Gonshorowski has said the first round will remove about 200 Nebraskans. Sarah Maresh of Nebraska Appleseed said the panel was the first she had heard that figure, and asked to see the underlying data. Her organization has estimated that as many as 40,000 could eventually lose coverage; disenrollments recur monthly, so the first round is not the measure of the policy.

Much of the confusion is over exemptions. The interim final rule CMS published one month after Nebraska started bars states from exempting people on their own attestation that a condition makes 80 hours impossible; beginning in 2028, enrollees must document it. Megan Word of the American Cancer Society Cancer Action Network said cancer patients are squarely in that gap, and that the state has said nothing about what such proof would consist of. Rules on matters as basic as travel outside one's own community remain unclear. Separately, eligibility redetermination moves from once a year to once every six months, so enrollees must reestablish both eligibility and exempt status twice as often.

The administrative side is already failing. Angela Lindstrom of the Health Center Association of Nebraska said callers wait as long as 90 minutes to reach a DHHS staff member, and some promised callbacks never came. The state has hired no additional staff for the rollout while under a budget crisis and hiring freeze. Lindstrom described a pregnant woman who arrived at an appointment believing she was covered and learned she had been denied — DHHS staff, she said, had simply missed that she was pregnant.

Cheri Stollar, who has covered herself and her five daughters through Medicaid while working since age 16, is also a mental health provider whose caseload is 85% Medicaid; she has lost two clients to the new rules already. State Sen. John Fredrickson of Omaha, who sits on the Legislature's Health and Human Services Committee, said the paperwork backlog is landing on a system already under strain, and that the schedule was a decision rather than an obligation: "This timeline was not required. It was chosen."