The new Medicaid policy in Nebraska is not immediately apparent. The calendar is what it is. May 1. Congress passed the One Big Beautiful Bill Act last summer, eight months ahead of the national deadline. No other state is making such rapid progress, and very few are trying to do so without hiring new employees. Nebraska is doing both.
Using the phrase “moral renewal,” Governor Jim Pillen announced the rollout while standing with Dr. Mehmet Oz, Administrator of the Centers for Medicare & Medicaid Services, on a video link. “This is a hand up, not a handout,” Pillen stated, presenting the new 80-hour monthly work, school, or volunteer requirement as a means of achieving stability and self-worth. Beaming from Washington, Oz described it as daring. He referred to it as “generational poverty.” There’s a feeling that something good is being constructed in those rooms. The atmosphere is different outside of them.
On a weekday morning, the line forms early as you pass the DHHS offices in Lincoln. Long before this policy was implemented, caseworkers there had been characterizing the system as overburdened for years. Approximately 16,000 to 41,000 Nebraskans on the Medicaid expansion rolls will now have to demonstrate each month that they are working enough hours, attending school, taking care of a family member, or engaging in approved community service starting next month. A large number of them already are. The odd thing is that. The great majority of those impacted by these regulations already comply with them.
They might not be able to demonstrate it in a timely manner using a system that has not yet been completed.
The CEO of Nebraska’s Department of Health and Human Services, Steve Corsi, openly acknowledged this. He stated that the organization is “currently looking at technology and existing resources and building a blueprint.” An outline. We’re out for six weeks. No new hires are anticipated. Other states are getting ready to hire dozens or even hundreds of new employees in anticipation of the federal deadline in 2027. The same employees who are already behind will be asked to take on more work by Nebraska.
Sarah Maresh, who oversees Nebraska Appleseed’s health care access program, used a term that is uncommon among policy professionals. “Afraid.” People are afraid, she said. It’s difficult to ignore the fact that the governor’s office’s talking points, which still emphasize independence and dignity, haven’t really incorporated fear. It is possible for both to be true simultaneously. There is dignity in work. Keeping your insulin prescription filled is also important.
Edison McDonald, the director of National Disability Action in Hickman, has worked with Medicaid-dependent families who wish to work for many years. Additionally, he has collaborated with DHHS leadership to enhance the very systems that are currently required to accomplish more with less. His assessment is straightforward: Nebraska isn’t prepared. Thousands of eligible individuals were removed from the rolls in other states that rushed similar requirements—Arkansas attempted this in 2018—because they were unable to complete the reporting, not because they were unemployed.
According to a June estimate from the Congressional Budget Office, 4.8 million physically fit adults would not have health insurance by 2034 as a result of the national work requirements. The test kitchen is in Nebraska. According to Pillen, 30,000 Nebraskans will be “put to work.” According to Appleseed, a comparable figure will merely lose coverage. Both may be correct. That’s what makes me uneasy.
Beneath the more prominent debate is a more subdued one concerning whether health care is something you have or something you earn. The leadership of Nebraska has taken a stand. It is a different matter entirely whether the paperwork can support the principle. It’s tempting to watch and see who is correct as this develops. That luxury might not be available to those who lose coverage on May 2.
