Lincoln, Nebraska — In less than two weeks, Nebraska will make history as the first state in the nation to enforce federal Medicaid work requirements — and hospitals and clinics say they’re not prepared for what’s coming.
Starting May 1, able-bodied Medicaid expansion enrollees between ages 19 and 64 must work, volunteer, or participate in qualifying activities for at least 80 hours a month to keep their coverage. Nebraska is moving eight months ahead of the national deadline set by Congress last year, and the fallout is already visible.
“Everyone’s just kind of guessing right now”
That’s how one clinic CEO put it. Brad Meyer, head of Bluestem Health in Lincoln, said his organization serves about 8,400 Medicaid patients. Based on what happened in states like Arkansas when similar requirements were tried, he estimates 10% to 15% could eventually be disenrolled. The financial hit? Somewhere between $400,000 and $600,000 per year.
“Whenever your uncompensated care goes up, you have loss of revenue on one side and then more patients who are uninsured on the other,” Meyer said. He doesn’t anticipate closure, but doesn’t know yet what services might have to be cut.
The Nebraska Hospital Association’s president and CEO, Jeremy Nordquist, said the state’s 92 hospitals are bracing for an influx of patients who simply don’t understand what the new rules require of them. About 30% to 40% of the 70,000 Nebraskans on Medicaid will need to have their hours verified manually — adding a significant administrative burden to an already strained system.
What nursing home residents need to know
People who live in a nursing home or similar facility are exempt from the work requirements. Nebraska’s DHHS, in guidance updated just days ago, confirms that nursing facility residents aren’t subject to the new rules. But the broader Medicaid disruption could still hit nursing homes indirectly: if workers, family members, or other support staff lose coverage, facilities could see staffing gaps and increased uncompensated care costs across the board.
The link between Medicaid work requirements and nursing home stability is real. As states have struggled to implement similar Medicaid rules before, providers consistently warn that the downstream effects reach far beyond the individuals directly disenrolled.
Nebraska as a national test case
Industry reports describe Nebraska’s rollout as a preview of what every other state could face. The federal government has told states to implement work requirements by January 2027. If Nebraska’s implementation turns chaotic — wrong disenrollments, administrative gridlock, coverage gaps — other states will have to decide whether to push ahead anyway.
CMS said in a statement that it’s supporting Nebraska with “ongoing coordination, policy guidance, technology support, and operational assistance.” After May 1, federal staff will help address “operational or technical challenges as needed.”
That language has done little to calm providers on the ground.
Nordquist’s association set up a dedicated website to help Nebraskans navigate the new requirements. His advice to anyone relying on Medicaid: update your contact information on the state portal now. Starting in 2027, re-verification will happen every six months instead of annually.
Nebraska’s experiment starts in less than two weeks. The rest of the country is watching.
