Nebraska Gov. Jim Pillen announced that his state is moving forward as the first in the nation to pursue work requirements for Medicaid expansion recipients, with implementation targeted for May 1, 2026.
Pillen was joined by Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz and Nebraska Department of Health and Human Services CEO Steve Corsi at a news conference, where the governor signed a letter to CMS outlining Nebraska's intent to adopt the requirements ahead of a federal deadline.
The policy stems from HR 1, known as the One Big Beautiful Bill, which requires able-bodied adults in the Medicaid expansion population to engage in work or other qualifying activities as a condition of receiving benefits.
"These requirements will help Nebraskans achieve greater self-sufficiency through employment and other meaningful activities," Pillen said.
"Working not only provides purpose," said the governor, "but helps people become active, productive members of their communities.
"Nebraska will be ready to move forward with these requirements prior to the federally mandated start of Jan. 1, 2027."
Under the plan, able-bodied adults ages 19-64 enrolled through Medicaid expansion would be required to complete at least 80 hours per month of work, approved job training, community service, or educational activities unless they qualify for an exemption.
"Across the nation, our goal is to support people engaged in meaningful work, involved in their communities, and connected to the support that sets them up for long-term success," Oz said. "Nebraska is leading the way as the first state to launch its community engagement requirements."
Oz noted in August that the work requirement should not be viewed as a barrier to medical coverage.
"Work is a great way of doing and getting you out of poverty if you can find jobs and elevate yourself," he said. "There have been efforts to do this in the past, but they haven't been able to achieve what we can achieve."
Technology will help recipients show they are working, said Oz. "What if we go beyond just proving that you tried the work to actually say, 'You know what, you didn't work enough, but we can actually help you by connecting you through an employment office?'" he said.
Nebraska state program administrators said current Medicaid recipients will be evaluated for compliance during their regular renewal process after the rule takes effect.
New applicants on or after May 1, 2026, would need to verify participation in qualifying activities or document an exemption.
Corsi said the changes are intended to support economic stability while addressing workforce needs.
"Employment provides financial stability, fosters personal growth, and will help Nebraska's small businesses in need of workers," Corsi said.
The requirements would apply only to the Medicaid expansion population and include numerous exemptions, such as individuals with disabilities, pregnant women, parents of young children, caregivers, people receiving substance use treatment, certain veterans, Native American tribal members and others specified under state and federal guidelines.
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