{"id":35997,"date":"2026-04-29T10:37:06","date_gmt":"2026-04-29T10:37:06","guid":{"rendered":"https:\/\/pickbydoc.com\/?p=35997"},"modified":"2026-04-29T10:37:07","modified_gmt":"2026-04-29T10:37:07","slug":"trumps-medicaid-work-mandate-debuting-in-nebraska-to-much-dismay","status":"publish","type":"post","link":"https:\/\/pickbydoc.com\/?p=35997","title":{"rendered":"Trump\u2019s Medicaid Work Mandate Debuting in Nebraska to Much Dismay"},"content":{"rendered":"<p> <br \/>\n<\/p>\n<div>\n<p>Schmeeka Simpson of Omaha works as a patient navigator for the American Civil Liberties Union and an administrative assistant at Nebraskans for Peace, plus picks up shifts at a Dunkin\u2019 shop.<\/p>\n<aside class=\"wp-block-kff-shared-sidebar alignright \">\n<\/aside>\n<p>Still, even with three jobs, she worries about losing her health coverage when Nebraska, on May 1, becomes the first state to require certain Medicaid enrollees to work, train, or go to school under a rule mandated by congressional Republicans\u2019 One Big Beautiful Bill Act.<\/p>\n<p>Simpson, 46, has relied on Medicaid since her divorce in 2014. None of her employers offers health coverage. She said she lost her government food assistance after technical problems caused her to miss renewing in time, and she doesn\u2019t trust the state to implement the new work rules without problems.<\/p>\n<p>\u201cAdding more barriers won\u2019t make the program work any better,\u201d she said.<\/p>\n<figure class=\"wp-block-image alignleft size-large is-resized\"><figcaption class=\"wp-element-caption\">Even though she works three jobs, Schmeeka Simpson worries about losing her health coverage when Nebraska becomes the first state to require certain Medicaid enrollees to work, train, or go to school under a new federal mandate. (Schmeeka Simpson)<\/figcaption><\/figure>\n<p>Nebraska Medicaid officials say they are trying to make it as easy as possible for enrollees to comply, so people don\u2019t lose their coverage for administrative reasons, such as failing to file the proper paperwork.<\/p>\n<p>Enrollees with one of thousands of health conditions detailed by the state would be exempt.<\/p>\n<p>\u201cOur top priority is making sure members clearly understand changes to the program and how to maintain their coverage,\u201d Drew Gonshorowski, the state\u2019s Medicaid director, said in an early-April news release.<\/p>\n<p>In a brief interview with KFF Health News on April 28 outside the National Press Club in Washington, D.C., Centers for Medicare &amp; Medicaid Services Administrator Mehmet Oz said he applauds Nebraska for being the first state to begin implementing the work requirements. He acknowledged that the state is still \u201cworking out the kinks,\u201d adding that his hope is \u201cby the end of this year they will get into a more sophisticated place.\u201d<\/p>\n<p>But health policy analysts, advocates for the poor, and health industry groups remain skeptical, fearing thousands of Nebraska Medicaid enrollees will lose coverage and, with it, their access to health services and protection from medical debt.<\/p>\n<p>Hospitals also worry an increase in uninsured patients will hurt their bottom lines, said Jeremy Nordquist, the president and CEO of the Nebraska Hospital Association.<\/p>\n<p>\u201cThere is a lot of concern on many different levels,\u201d he said. Many enrollees are unaware of the changes and might not realize they have to act to stay insured, he said.<\/p>\n<p>The bill President Donald Trump signed last July requires the 42 states, along with the District of Columbia, that fully or partially expanded Medicaid under the 2010 Affordable Care Act to implement a work requirement starting in 2027. The full expansion enables adults with incomes of up to 138% of the federal poverty level \u2014 amounting to $22,025 for a single person this year \u2014 to be eligible for Medicaid, the government program covering people with low incomes or disabilities.<\/p>\n<p>More than 20 million people gained coverage from Medicaid through expansion, according to KFF, a health information nonprofit that includes KFF Health News. The Congressional Budget Office estimates 4.8 million will become uninsured over the next decade as a result of the work requirement.<\/p>\n<p>Under the law, enrollees must work or volunteer at least 80 hours a month, attend school at least part-time, or participate in job training. Or they must prove they qualify for certain exemptions, such as caring for a child 13 or younger or a disabled parent, or having a health condition that prevents employment.<\/p>\n<p>Some states explored implementing work rules in the years before the GOP law passed. It gave states the option to launch their programs early.<\/p>\n<p class=\"has-heading-5-font-size\"><strong>Nebraska\u2019s Plan<\/strong><\/p>\n<p>In Nebraska, which is implementing the provision eight months before the law requires, about 70,000 Medicaid enrollees will need to meet the requirement, said Collin Spilinek, a spokesperson for the Nebraska Department of Health and Human Services.<\/p>\n<p>About 72% of them probably won\u2019t have to do anything to keep their coverage, because the state already knows their work or exemption status via state or national databases, Spilinek said.<\/p>\n<p>To check whether enrollees meet the requirement, Nebraska and other states plan to tap into various databases, including Medicaid claims information and data controlled by credit rating agencies. Enrollees for whom Nebraska doesn\u2019t have data will be notified and can complete an online form to confirm they meet the new rules.<\/p>\n<p>While a number of states say they <a href=\"https:\/\/kffhealthnews.org\/news\/article\/medicaid-cuts-work-requirements-state-staff-shortages\/\" target=\"_blank\" rel=\"noopener\">plan to hire<\/a> extra administrative staff, the Nebraska Medicaid agency is not adding any employees to implement its work requirement.<\/p>\n<p>\u201cThe fact that they say they do not need additional resources raises questions\u201d as to whether \u201cthey will be able to pull this off without future headaches,\u201d Nordquist said.<\/p>\n<div class=\"wp-block wp-block-kff-shared-newsletter  wp-block-kff-shared-newsletter--background-white\" data-type=\"kff-shared\/newsletter\" data-align=\"center\">\n<div class=\"wp-block-kff-shared-newsletter__container\">\n<div class=\"wp-block-kff-shared-newsletter__content\">\n\t\t\t<img decoding=\"async\" src=\"https:\/\/kffhealthnews.org\/wp-content\/plugins\/kff-shared\/dist\/\/images\/newsletter-icon.png\" alt=\"Newsletter Icon\" class=\"wp-block-kff-shared-newsletter__img\"\/><\/p>\n<div class=\"wp-block-kff-shared-newsletter__text\">\n<h4 class=\"newsletter__title\">\n\t\t\t\t\tEmail Sign-Up\t\t\t\t<\/h4>\n<p class=\"newsletter__description\">\n\t\t\t\t\tSubscribe to KFF Health News&#8217; free Morning Briefing.\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\n<p>Proving employment status will require documentation, but Nebraska officials say they will allow enrollees to self-attest that they volunteer, go to school, or qualify for exemptions, such as for poor health or caring for a disabled parent. \u201cSupporting documentation, such as medical records, will not be required,\u201d Spilinek said.<\/p>\n<p>That could make it easier for enrollees to get exempted under the law\u2019s \u201cmedical frailty\u201d exception. The long list of health conditions that can be considered for the exemption was posted last week by the state and includes many types of cancers and mental health and heart conditions.<\/p>\n<p>Kelsey Arends, senior staff attorney for Nebraska Appleseed, an advocacy group, said the state\u2019s long list of medical billing codes for conditions that would be exempted is still not long enough. She said different levels of illness severity are not included.<\/p>\n<p>The exemption is crucial for Crystal Schroer, 30, who has been on Medicaid since 2022 and unemployed since 2024. She said it has been difficult to find work near her home in Kearney, Nebraska, that will allow her to take along her psychiatric service dog, Tarot, who helps her with anxiety.<\/p>\n<p>\u201cI am insanely worried,\u201d said Schroer, who lives with a friend. \u201cIt\u2019s made my depression way worse.\u201d<\/p>\n<p>Whether self-attestation will broadly be allowed in other states will depend on CMS\u2019 rules for work requirements, expected to be set this summer. Oz told KFF Health News that \u201cwe don\u2019t like self-attesting\u201d and that \u201cdocumentation is critical.\u201d<\/p>\n<p>Several advocacy groups had asked the state to exempt enrollees with specific conditions, including the American Diabetes Association, HIV+Hepatitis Policy Institute, and National Bleeding Disorders Foundation. Losing coverage, the groups said, would mean losing access to medications that keep people healthy and out of the hospital.<\/p>\n<p>Adding a work requirement to Medicaid has been a priority for Trump since his first term. In 2018, his administration became the first to allow states to adopt the policy, but only Arkansas implemented it. In the nine months the policy was in place before a federal judge deemed it unlawful, more than 18,000 people lost coverage \u2014 nearly 1 in 4 of those subject to the requirement.<\/p>\n<p>Most lost coverage not because they did not meet the requirements but for failing to correctly submit paperwork in time.\u00a0<\/p>\n<p>Georgia has had a work requirement under its partial Medicaid expansion since 2023. Only about 8,000 people signed up for the coverage in its first two years \u2014 far fewer than the 25,000 that state officials predicted for the first year alone \u2014 and many have been denied benefits because of paperwork issues.<\/p>\n<p class=\"has-heading-5-font-size\"><strong>National Mandate<\/strong><\/p>\n<p>During the congressional debate over the law last year, Republicans pushed a work requirement for Medicaid as a way to get \u201c<a href=\"https:\/\/kffhealthnews.org\/news\/article\/medicaid-words-language-debate-public-opinion-house-budget\/\" target=\"_blank\" rel=\"noopener\">able-bodied<\/a>\u201d adults benefiting from government assistance into the workforce. House Speaker Mike Johnson said <a href=\"https:\/\/kffhealthnews.org\/news\/article\/medicaid-work-requirements-disabled-insurance-big-beautiful-bill-gop\/\" target=\"_blank\" rel=\"noopener\">it would help preserve Medicaid<\/a> \u201cfor people who rightly deserve it,\u201d not young men \u201csitting on their couches playing video games.\u201d<\/p>\n<p>Republicans have argued mandating employment will nudge people into finding work, leaving Medicaid to help children and people who are pregnant or have disabilities.<\/p>\n<p>They were not swayed by studies showing <a href=\"https:\/\/www.kff.org\/medicaid\/understanding-the-intersection-of-medicaid-and-work-an-update\/#:~:text=This%20brief%20updates%20an%20earlier,work%20requirements%20under%20previous%20policies\" target=\"_blank\" rel=\"noopener\">most adults on Medicaid<\/a> already work or go to school or have health conditions preventing them from doing so.<\/p>\n<p>A <a href=\"https:\/\/www.acpjournals.org\/doi\/10.7326\/ANNALS-25-04811\" target=\"_blank\" rel=\"noopener\">recent study<\/a> in the Annals of Internal Medicine found about one-third of adults at risk of losing coverage under the new work requirement reported that they have a physical or mental illness or disability.<\/p>\n<p>\u201cThis is not a case that we have mostly healthy adults choosing not to work,\u201d said Darshali Vyas, a study co-author and health policy researcher at Beth Israel Deaconess Medical Center in Boston. \u201cIt\u2019s a vulnerable group, and I am not sure there are clear protections as we begin to roll out work requirements.\u201d<\/p>\n<p>In Nebraska, about two-thirds of Medicaid expansion enrollees <a href=\"https:\/\/www.kff.org\/medicaid\/a-closer-look-at-nebraska-the-first-state-planning-to-implement-a-medicaid-work-requirement\/\" target=\"_blank\" rel=\"noopener\">work or attend school<\/a>, according to KFF. Nebraska\u2019s unemployment rate is 3%, one of the lowest in the nation.<\/p>\n<p>Andrea Skolkin, the CEO of Omaha-based One World Community Health Centers, said it\u2019s an unsettling time for her clinic and their patients. \u201cWe are still concerned about the expanded Medicaid folks losing coverage,\u201d she said.<\/p>\n<p>About 4,000 of their 52,000 patients are covered under the Medicaid expansion, Skolkin said. She said many enrollees received letters from the state about the work requirement, but she worries many did not understand them.<\/p>\n<p>Losing 10% of those patients would mean $500,000 less in revenue for the nonprofit centers, she said. To help patients, they plan to add staff to help people fill out the forms to get and maintain coverage.<\/p>\n<p>Nebraska Appleseed\u2019s Arends said she\u2019s skeptical of the state\u2019s promises to use automation to confirm that enrollees meet the work rules. \u201cWe remain very concerned about the early implementation,\u201d she said.<\/p>\n<p>People who lose coverage may have a harder time getting health bills covered if they reenroll in the Medicaid program, because the federal law also reduces retroactive eligibility from three months to one month for expansion enrollees.<\/p>\n<p>Because many people sign up for Medicaid when seeking care for an emergency and it can take weeks or months to complete enrollment, hospitals are concerned the change will leave them to cover the costs when people lose coverage, Nordquist said.<\/p>\n<p>Only two other states plan to implement the work requirement early: Montana, which plans to launch in July, and Iowa, which plans to go live in December.<\/p>\n<p>Many states will be closely watching Nebraska\u2019s implementation to see what lessons they can learn ahead of their own launches in January, said Andrea Maresca, a senior principal at Health Management Associates, a consulting firm.<\/p>\n<p>States are better prepared to enact work requirements than they were when Arkansas tried in 2018, she said. After reconfirming millions of enrollees\u2019 eligibility post-covid, they have more experience using public and private databases to automate the process and more practice communicating with enrollees, Maresca said.<\/p>\n<p>Still, \u201cit won\u2019t be perfect,\u201d and states will have to adapt as they go, she said.<\/p>\n<\/div>\n<p><br \/>\n<br \/><a href=\"https:\/\/kffhealthnews.org\/medicaid\/nebraska-medicaid-work-requirement-fears-losing-coverage\/\" target=\"_blank\" rel=\"noopener\">Source link <\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Schmeeka Simpson of Omaha works as a patient navigator for the American Civil Liberties Union and an administrative assistant at Nebraskans for Peace, plus picks up shifts at a Dunkin\u2019 shop. Still, even with three jobs, she worries about losing her health coverage when Nebraska, on May 1, becomes the first state to require certain [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":35998,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[171],"tags":[],"class_list":["post-35997","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-conditions"],"jetpack_publicize_connections":[],"_links":{"self":[{"href":"https:\/\/pickbydoc.com\/index.php?rest_route=\/wp\/v2\/posts\/35997","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pickbydoc.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pickbydoc.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pickbydoc.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/pickbydoc.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=35997"}],"version-history":[{"count":1,"href":"https:\/\/pickbydoc.com\/index.php?rest_route=\/wp\/v2\/posts\/35997\/revisions"}],"predecessor-version":[{"id":35999,"href":"https:\/\/pickbydoc.com\/index.php?rest_route=\/wp\/v2\/posts\/35997\/revisions\/35999"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pickbydoc.com\/index.php?rest_route=\/wp\/v2\/media\/35998"}],"wp:attachment":[{"href":"https:\/\/pickbydoc.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=35997"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pickbydoc.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=35997"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pickbydoc.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=35997"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}