Nebraska becomes first state to disenroll Medicaid recipients under new work requirements

Cheri Stollar and her five daughters have only ever received medical coverage through Medicaid. Despite going to college and working, sometimes multiple jobs, since she was 16 years-old, she said she's never been able to make enough money to pull her family out of poverty.

“I hate the myth that people who need these resources are lazy,” Stollar said. “I think access to medical care is vital for everyone. You shouldn’t only be able to take care of your medical needs if you have money.”

Stollar spoke Friday morning as part of a panel of activists and experts on how Nebraska’s rush to implement new Medicaid requirements will impact people who need medical care. Hosted by advocacy group Nebraska Appleseed, the discussion centered around Nebraska’s disenrollment of the first round of Medicaid recipients who no longer qualify for coverage under changes from the One Big Beautiful Bill Act.

Able-bodied enrollees will have to log at least 80 hours a month of employment, work program attendance, volunteering or schoolwork. These apply to Medicaid members between the ages of 19 and 64 who are not pregnant, do not have a disability, are U.S. citizens or meet immigration rules and make less than 138% of the federal poverty level. Nebraska’s Department of Health and Human Services (DHHS) estimates that this is about $22,000 a year for a single person and around $45,500 a year for a family of four.

In her work as a mental healthcare provider, Stollar said 85% of her patients are on Medicaid. She said she’s lost two clients already due to new eligibility requirements. The requirements aren’t just hitting home for her own family, it’s also causing hardship for low-income families.

“I feel like it's like kicking people when they're down,” Stollar said. “People are already struggling. I don't understand. I just don't understand the reasoning.”

Nebraska is the first state in the nation to implement these requirements. Gov. Jim Pillen implemented the new Medicaid work requirements eight months ahead of schedule, which went into effect in Nebraska on May 1 this year. Pillen said that he intentionally opted into the new requirements early because he wants to reduce the size and cost of the program.

“Nebraska is proud to be the model for fellow states implementing Medicaid Work Requirements,” Pillen wrote in a statement. “Able-bodied adults who can work, and choose not to, shouldn't receive taxpayer-funded welfare benefits.”

Medicaid and Long-Term Care Director Drew Gonshorowski said that the first round of disenrollments will remove around 200 Nebraskans from coverage.

Sarah Maresh, Health Care Access program director with Nebraska Appleseed, said this was the first time she had heard that number. Nebraska Appleseed had previously estimated that up to 40,000 Nebraskans could eventually lose coverage under the changes. Maresh pointed out that Medicaid disenrollments will continue monthly, and more will lose benefits as time goes on. She said the number of applicants who will be denied is unclear, and she would like to see the dataset Gonshorowski referenced.

“For 61 years, Medicaid has been a lifeline for millions of Nebraskans and our hospitals in our state,” Maresh said. “Nebraskans just can't afford this.”

Maresh said the last three months have caused a great deal of confusion for Medicaid enrollees and potential enrollees. Some exemptions are unclear, such as rules around traveling outside of one’s own community, or how medical frailty exemptions will change under the new rules, leaving people with serious medical conditions behind. Megan Word with the American Cancer Society Cancer Action Network, said that in particular will put cancer patients in a tight spot.

An Interim Final Rule was published one month after Nebraska began implementing the new Medicaid guidelines, which prevents states from granting exemptions to people based on their attestations that their conditions and diseases make it impossible for them to work 80 hours a month. Instead, starting in 2028, patients will have to prove that their ailments prevent them from working. But Word said it is unclear how they are meant to prove it.

“The state has been absolutely silent on what that will look like,” Word said.

Maresh added that the new requirements change redetermination of eligibility from an annual process to a biannual process. Patients will have to prove their eligibility, and their exempt status, once every six months. She worries that not only the frequency but the complexity of how patients can prove how their medical conditions impact them will deter both current and potential enrollees from applying at all.

“People want to do the right thing. They want to follow the rules,” Maresh said. “But when we don’t even know what the rules are, it makes it incredibly difficult.”

At the same time, Angela Lindstrom, communications director with the Health Center Association of Nebraska, said people with questions about their applications have been waiting up to 90 minutes to speak with a DHHS staff member. No additional staff have been hired to help with the implementation of the new Medicaid requirements as the state grapples with a budget crisis. Some who were told that they would receive a call back with an answer to their questions never received that call at all, Lindstrom said.

“We even saw just last week where a pregnant woman showed up at her appointment thinking that she had it, and found out she was denied,” Lindstrom said. “She should have been eligible for Medicaid. [DHHS staff] just basically said that they missed that she was pregnant. So there’s a lot of confusion going on.”

State Sen. John Fredrickson, who represents parts of Omaha and sits on the Legislature’s Health and Human Services Committee, said the state is in a crisis when it comes to access to medical services. And while the backlog seems like a paperwork problem to staff, it can result in patients losing access to medication or missing doctors appointments.

“This is landing on top of a system that's already really struggling,” Fredrickson said. “This timeline was not required. It was chosen.”