KVIG Informative

Nebraska will remove roughly 200 people from Medicaid this weekend for failing to meet new federally mandated work requirements — the first coverage losses of their kind in the country, months ahead of the national deadline.

Nebraska becomes the first state in the nation to strip Medicaid coverage from enrollees for failing to meet new work requirements, with the state’s Medicaid director telling the nonprofit news organization Tradeoffs that roughly 200 Nebraskans will lose coverage August 1.

The work requirements stem from the tax and spending law President Trump signed in 2025. Under the federal rules, about 20 million people across 44 states must work or volunteer 80 hours a month, attend school, or participate in job training to keep their Medicaid benefits. States have until January 1, 2027 to implement the requirements, but Nebraska chose to launch months early.

Nebraska Medicaid Director Drew Gonshorowski said the state is positioned to lead because it runs its own eligibility system, which can confirm compliance for roughly three-quarters of the estimated 70,000 Nebraskans subject to the requirements without contacting them directly, according to the Tradeoffs interview.

Supporters of the policy, including Gonshorowski, argue work requirements will move people toward economic stability and save the federal government an estimated $325 billion over ten years. Research on prior state-level work requirement experiments has found the policies did not meaningfully increase employment, and found many people who lost coverage were eligible but tripped up by paperwork or unaware of the new rules.

Estimates of the national coverage loss vary widely, ranging from roughly 3 million to as many as 8.6 million people losing Medicaid by 2028. Nebraska alone expects an estimated 30,000 people to eventually fall under the requirements.

The Center on Budget and Policy Priorities warned in April that Nebraska’s early rollout, combined with the state’s decision not to hire additional staff to handle the transition, could lengthen application processing times and call wait times for all Medicaid enrollees — not just those newly subject to work requirements — increasing the risk that eligible people lose coverage due to administrative delays rather than actual noncompliance.

Montana is expected to follow Nebraska’s early timeline, and 42 states plus Washington, D.C. are required to have the policy in place by the federal deadline. What happens in Nebraska over the next several weeks — how many of the roughly 200 people who lose coverage this weekend get it back, and how many simply disappear from the rolls — will shape how the rest of the country implements the biggest change to Medicaid since the Affordable Care Act.