Jeffrey Due worries that his family’s healthcare is in limbo as Nebraska becomes the first state to roll out new federal Medicaid work requirements.
Due, a small business owner in York, relies on Medicaid coverage for his two stepsons with developmental disabilities — and they have limited employment options. Due himself was diagnosed with primary progressive multiple sclerosis in 2023, a neurological condition that impacts his ability to work.
“If you know anything about MS, you know that it never gets better, it never goes away, and today is as good as I’m gonna get for the rest of my life,” Due said. “On paper, families like mine are supposed to be protected from these new requirements.”
As Nebraska voluntarily implements the new requirements months ahead of the federal government’s deadline, Due says he’s waiting for clear answers that haven’t come.
Nebraska’s initial Aug. 1 implementation date has now passed, and the first details are emerging about how the rules will work. In response to questions from Flatwater Free Press, Nebraska’s Department of Health and Human Services clarified some of its plans for implementation.
But as Nebraskans start to lose healthcare coverage, the state has not released up-to-date numbers showing how many people have been denied Medicaid or why. Healthcare advocates and patients say their questions have gone unanswered, especially as federal rules around work requirements have changed in recent weeks.
“All states I think are dealing with these same questions about how to operationalize the new requirements … The only difference is Nebraska’s pushing ahead despite not having any of those questions answered,” said Megan Word, Nebraska government relations director for the American Cancer Society Cancer Action Network. “And we just don’t know how they’re doing it. So it’s pretty scary.”
Nebraska’s Medicaid work requirements, which went into effect in May, apply to the roughly 70,000 Nebraskans who are in the Medicaid expansion population, people ages 19 to 64 who earn up to 138% of the federal poverty level, or about $22,205 for a single adult.
According to the state’s initial work requirement rules, Medicaid enrollees now must:
- Spend at least 80 hours per month in school, working, participating in a work program or volunteering.
- Alternatively, earn at least $580 per month, which is the equivalent of 80 hours of work making the federal minimum wage. Because Nebraska’s minimum wage is about double the federal minimum wage, a person would need to work only around 40 hours per month at minimum wage.
- Meet those work hours or wage requirements for only one month out of the previous 12 months. In 2027, that will change to every six months, as recipients will need to renew twice per year.
People with conditions that render them medically frail, like Due, can declare themselves medically frail through 2027 without further documentation from doctors, according to DHHS.
That process will change on Jan. 1, 2028, because federal rules do not allow people to attest on their own to their conditions, and more information about those changes will be forthcoming, DHHS said in a bulletin to providers.
Other exemptions from work requirements include: people with tribal affiliations, people who are younger than 26 and aged out of foster care, caretakers for children 13 and under or people with disabilities, people who are pregnant or less than one year postpartum and people receiving treatment for substance-use disorders.
One of Due’s stepsons, Lance Taylor, worked at a Tractor Supply Co. for the past five years, cleaning bathrooms for a couple hours per day, Due said.
The arrangement worked well for Taylor, who has a developmental disability, until he lost his job after a change in management, he said.
“We can’t get another job for him around here. We’ve tried,” Due said. “If they’re gonna suddenly have work requirements for him, where are we gonna go?”
Due’s multiple sclerosis is one of thousands of diagnostic codes included in DHHS’s index of conditions that qualify for a medically frail exemption from the work requirements. Despite that, Due said he is still struggling to qualify for Medicaid.
“They list my condition as being kind of an automatic approval, but I’m still not approved. I’ve been declined twice,” Due said. “Short of taking them to my next neurology appointment, I don’t know what else to do to prove it.”
DHHS said that for existing Medicaid beneficiaries, it first tries to use any claims data from previous doctor visits and diagnoses to see if the person has a qualifying condition for an exemption. In many cases, DHHS said, it can determine this without reaching out to ask for more information.
Those who are determined by DHHS to meet work requirements at their regularly scheduled renewal will receive an approval notice telling them they are in the adult expansion group and how to continue to meet work requirements, DHHS said.
If DHHS does not have enough information to make a determination, it will mail a notice giving the person 30 days to fill out additional paperwork verifying that they meet the requirements or are exempt.
Incoming federal changes
Currently, Nebraska conducts Medicaid expansion renewals yearly, but President Donald Trump’s 2025 tax and spending bill requires eligibility checks every six months instead, starting in 2027. That will mean Nebraskans need to meet the work requirements or prove an exemption twice per year.
In 2028, the process for getting a medical frailty exemption also is set to become more complicated. The federal Centers for Medicare & Medicaid Services released new guidelines in June that require medically frail people like Due and his family prove they cannot work, said Katherine Hempstead, senior policy officer at the Robert Wood Johnson Foundation.
“The rule is saying it’s not enough to be exempt from work requirements just because you have a certain condition, but you also ultimately need to provide some kind of evidence or documentation that that condition prevents you from working,” Hempstead said.
The new rules also will require doctors to provide documentation and sign off on medically frail patients’ six-month renewals starting in 2028, which may become extremely burdensome for providers, Hempstead said.
Changes to the medically frail exemption also will impact patients and present some particularly dangerous implications for cancer patients, said Word from the American Cancer Society Cancer Action Network.
“In essence, this (rule) will require cancer patients and the survivors who are suffering from treatment or lingering symptoms from their cancer treatment to prove that they can’t work in order to keep their Medicaid coverage,” Word said. “And they’re having to prove that they can’t work in a process that right now remains uncertain and confusing.”
Losing coverage for even a month could be deadly for patients who are undergoing treatment for a serious illness, Word said.
The American Cancer Society surveyed 1,400 cancer patients and survivors in July and found that 90% said that their cancer care or treatment required them to miss hours of school, work or volunteering, Word said.
About 75% said that it would be difficult for them to successfully submit paperwork within a 30-day window proving their cancer made them unable to work or attend school or volunteer. More than 80% said that they were already overwhelmed with juggling many tasks essential to their survival.
“Think about being diagnosed with cancer, if you’re somebody who’s relying on Medicaid for your healthcare coverage, because of Nebraska’s new system… you now also have to get ready to prove your ability to work or not work every six months in order to hang on to your healthcare,” Word said.
Lack of information
As of July 19, DHHS said it had denied 65 applications for renewal. DHHS does not have an estimate of how many members will lose coverage during August, but the department said in a statement that it “is working to begin public reporting of federally and state-required data regarding the Medicaid work requirements.”
The Flatwater Free Press filed a public records request asking for the total number of new Medicaid applicants denied under the work requirements since May. In response, DHHS said it would not be able to provide that data until late September.
Medicaid renewals are based on the month that the person originally applied, so people will initially lose coverage due to the work requirements in 12 waves, starting in August, said Sarah Maresh, health care access program director at Nebraska Appleseed.
Advocates don’t know how many people are expected to lose coverage each month.
“The state has information but has not shared how many people. They could tell us. They could tell anyone,” Maresh said.
Healthcare advocates across the state report hearing that Medicaid recipients are confused about new work requirements and worried that they will suddenly lose coverage. Many Nebraskans don’t know if they are part of the expansion group, Maresh said.
“We’ve heard that there’s been a deterrent effect where people are saying, ‘Well, I can’t meet the work requirements, I’m not going to apply,’” Maresh said, “when we know people are frequently eligible for Medicaid under other categories that don’t even have the work requirements. And there’s a lot of different ways people can meet it, and people just aren’t aware of that.”
Gov. Jim Pillen said in December that no additional staff would be hired to manage the work requirements. DHHS confirmed that it has not hired anyone.
“DHHS is leveraging its existing eligibility and verification workforce, which already perform complex eligibility determinations and verification functions,” DHHS said.
Between December 2025 and April 2026, DHHS said it sent mailers in English and Spanish to the entire Nebraska Medicaid expansion population, and since then has distributed instructional videos, a statewide public service announcement campaign, social media outreach and ongoing community presentations and meetings.
Healthcare advocates argue the state should step up communication efforts and start releasing data about who’s losing coverage.
Without news coverage, Due said he wouldn’t know anything about the upcoming changes to medical frailty that will impact his family. Even though his stepsons should also qualify for an exemption through their developmental disabilities, Due said he’s waiting to get an official notice.
“Thankfully, for my stepsons right now, things are still working OK,” he said. “But if we wind up with the worst-case scenario, with both of them taken off of the rolls, there’s no way that my family can afford it. We can’t … we can’t handle it.”
5 Comments
Well look here, another anecdotal sob story article with no new information about the actual newsworthy event it is based on.
Exemptions exist, as the article itself admits. And even if you were required to “work,” the actual requirement itself is written in such a way that even at minimum wage you only need to work part time. You don’t even need to do that until 2028, since for now you can still self-attest a medical condition.
DHHS can’t say the exact number of people who have lost coverage for one very obvious reason: Appeals. Everyone is entitled to an appeal if they lose coverage and those appeals take months. As such, likely very few people (if anyone at all) has truly lost coverage and been given a final denial of their appeal.
The real problem, barely touched in here, is the wait times for even legitimate coverage holders to talk to anyone at DHHS due to the increased workload.
Good insights as usual, FI.
Did you catch the FFP article on expensive housing in Lincoln, where at least one subject used fake pronouns?
The irony of an FFP editor ragging on you for not posting under your “real” name, while allowing others to choose fake pronouns–indeed, promoting the use of fake pronouns!– is so typical.
Maybe FFP should hire us as freelance writers?
This is what people wanted and voted for, and this is what they got. Trump made that absolutely clear. No one could have missed it.
But everyone was thinking, “Oh, he’s talking about illegals getting Medicaid, not Grandma, or my little girl.
WRONG! Racism blinded them. They desperately wanted to stick it to those damned illegals. They never thought that they would be seen and treated exactly the same.
If an anyone or anything devalues one human life, they will have absolutely no problem coming up with plenty of reasons to devalue the lives of you and yours whenever it suits them.
But, this is what the American people said they wanted. Maybe instead of complaining, y’all should have a parade or something to commemorate the occasion of electing a politician who is actually doing what he said he would do.
Yes, maybe I should have a parade. Because as you say, this is what many people voted for: An administration that would protect public benefits by ensuring the people who are truly entitled to those benefits are getting them.
And perhaps my parade would ignore the fact that this only partly has anything at all to do with Trump, since the law itself was written by Congress and is being implemented by the State of Nebraska. Context is overrated, right?
But one hitch in your theory… You say that we are complaining. I don’t believe very many people actually are complaining. I believe that what happened here is what typically happens when Flatwater tries to put pen to paper. They located the saddest sob story they could find, with the most outrageous circumstances, then reported on that singular case as if it were a common circumstance that everyone is facing. But actually, probably many people who rely on public benefits have had much less difficulty, and perhaps no difficulty at all in some cases. So the only real “complaining” that is happening is coming from one particular side of the political aisle…
“Even though his stepsons should also qualify for an exemption through their developmental disabilities”
BUT, at least has already proven he can work. Regardless of the unavailability of paid work in the area, the Medicare regs allow for community-service type of volunteer work in lieu of paid work.
There are MILLIONS of MS and disabled folks who contribute to their communities through volunteer work.