Nebraska will be the first state in the nation to implement work requirements for Medicaid expansion members, Governor Jim Pillen announced Wednesday.
Pillen, joined by state senators and Department of Health and Human Services (DHHS) CEO Steve Corsi at the state capitol, signed a letter detailing the state would put the requirements in place on May 1, 2026. The letter was addressed to the Centers for Medicare & Medicaid Services (CMS) Dr. Mehmet Oz, who joined the conference via video call.
The updated requirements are the result of HR1, the One Big Beautiful Bill. Among its provisions, able-bodied adults ages 19-64 in the Medicaid expansion population will need to participate in 80 hours of work, approved work programs, community service, or educational activities per month to maintain their benefits, unless they qualify for an exemption.
Nebraska will outpace other states by eight months. The federally mandated start date is Jan. 1, 2027.
“These requirements will help Nebraskans achieve greater self-sufficiency through employment and other meaningful activities,” said Pillen. “Working not only provides purpose but helps people become active, productive members of their communities.”
Current Nebraska Medicaid members will be assessed for the new requirements during their regularly scheduled renewal after the implementation date. Individuals applying for Medicaid on or after May 1, 2026, will need to provide verification of their community engagement activities or qualifying exemption.
“CMS will be working together with Nebraska and its 50 counterparts to ensure every program is implemented smoothly, responsibly, and in compliance with federal law,” said Dr. Oz.
DHHS CEO Steve Corsi said the changes will encourage “encouraging greater economic and social participation.”
Individuals excluded from this requirement include:
- People who are disabled
- People who are currently in foster care
- People through age 25 who aged out of foster care
- Members of recognized Native American tribes
- Pregnant women
- Parents or guardians of children up to age 13
- Caregiver of an individual with disabilities
- Disabled veterans (with a ‘total’ disability status)
- People who are medically frail
- People compliant with work requirements under the SNAP or TANF programs
- People receiving treatment for a substance use disorder
- People who are incarcerated or have been within the last 90 days
- People who qualify for Medicare Part A or Part B
Medicaid expansion includes individuals 19-64 with low incomes who receive health coverage through Nebraska Medicaid. Eligibility is based on income up to 138 percent of the federal poverty level (in 2025 for a single person was $21,610, or for a family of four was $44,380).
Nebraska Medicaid will use available data to verify compliance during application and renewal. If verification cannot be completed, members will be responsible for submitting documentation. Individuals found non-compliant will receive notice and have 30 days to meet the requirement or claim an exemption before denial or disenrollment.
Individuals seeking assistance with employment opportunities may use the Nebraska Department of Labor’s job service at neworks.nebraska.gov. More information regarding the requirement can be found at dhhs.ne.gov/workrequirements.