Who has to meet Nebraska's Medicaid work requirement?

Only adults in Nebraska's Medicaid expansion group, generally ages 19 to 64, who don't qualify for an exclusion. They must work, volunteer or join a work program for 80 hours a month, attend school at least half-time, or earn at least the federal minimum wage times 80 hours (about $580 a month). The state checks one month at application and one month per eligibility period at renewal.

Are family caregivers of people with disabilities exempt in Nebraska?

Yes. Nebraska's state plan amendment excludes a parent, guardian, caretaker relative or family caregiver of a child 13 or younger or of a disabled individual. People who are medically frail, pregnant or postpartum, in drug or alcohol treatment, or veterans with a total disability rating are also excluded. The state has to know a person fits an exclusion, so reporting it before renewal matters.

What happens if someone misses a Nebraska work-requirement notice?

When DHHS can't confirm compliance from its own data, it sends a notice of noncompliance and gives the person 30 days to show they meet the rule or are excluded. KFF Health News reported that most of Nebraska's roughly 1,100 work-rule denials as of August came from people not responding to requests for information.

Nebraska work rules at 6 months: 1,100 denials, call surge

Nebraska's Medicaid work rules, live since May 1, led to about 1,100 denials by August as calls to the state rose 66%, KFF Health News reported. Officials call the rollout a success; advocates say most losses come from unanswered paperwork. Here is who the rules cover and who is excluded.

Direct Support News desk · November 10, 2026 · Updated November 10, 2026 · 5 min read

Six months after Nebraska became the first state to enforce the Medicaid work requirement in the 2025 federal budget law (H.R. 1), its rollout has produced roughly 1,100 denials, a surge in calls to the state and a sharp split between officials who call it a success and advocates who say people are losing coverage over paperwork. KFF Health News reported the findings Nov. 10 using state records it obtained through public records requests; Nebraska Public Media covered an Omaha town hall on the six-month mark on Nov. 9. The rules themselves are set out in the state's approved state plan amendment NE 26-0002.

What the numbers show, as of August

About 70,000 adults in Nebraska's Medicaid expansion group are subject to the requirement, which took effect May 1, eight months before the Jan. 1, 2027, national start. According to KFF Health News:

About 1,100 denials tied to the work requirement as of August, most because people didn't respond to requests for information.
Total Medicaid enrollment fell by about 4,600 people since May, a 1.4% drop, according to an August state report. That figure covers all enrollees, not only work-rule losses.
Average call-center wait times nearly doubled, from about 13 minutes in May to 26 minutes in July, before easing in August. The state took more than 101,000 calls in August, up 66% from May.
$8.2 million in contractor costs over two years appear in state health department documents for carrying out H.R. 1's Medicaid changes, including the work rule, from two firms that supply staff to the agency. A department spokesperson said those funding requests may not match actual spending.

State officials point to different numbers. Jeff Powell, a spokesperson for the Nebraska Department of Health and Human Services (DHHS), told KFF Health News the rollout "has been very successful," citing state data that 86% of affected applicants met the requirement or qualified for an exclusion and 93% of existing enrollees kept coverage. Those shares are in line with the early breakdown the state gave its Medicaid Advisory Committee in September, which Direct Support News covered on Sept. 29.

At the Omaha town hall, a community health worker told Nebraska Public Media some of her clients have stopped applying because the rules are confusing, and that some callers wait up to two hours. Nebraska Appleseed's Sarah Maresh said the group's data, about two months old, showed more than 1,000 Nebraskans denied or cut off.

KFF Health News also described an Omaha man with kidney cancer who said he was told he had lost Medicaid for not meeting the work rule and canceled tests as a result. DHHS disputes that account: it says he had no lapse in coverage and left Medicaid when he turned 65 and moved to Medicare, before the work rule could apply to him.

Who the rule covers, and who it doesn't

Nebraska's state plan amendment applies the requirement only to the adult expansion group (42 CFR 435.119). People enrolled through other Medicaid eligibility groups are not subject to it, and anyone entitled to Medicare is treated as meeting it. Within the expansion group, a person meets the requirement for a month by doing any of the following:

working, doing community service or taking part in a work program for at least 80 hours, or a combination of those;
being enrolled in school at least half-time; or
earning at least the federal minimum wage times 80 hours a month (about $580 at $7.25 an hour).

The plan excludes several groups entirely, including people who are medically frail or have special medical needs; a parent, guardian, caretaker relative or family caregiver of a child 13 or younger or of a disabled individual; veterans with a total disability rating; people in drug or alcohol treatment; pregnant and postpartum enrollees; and people complying with TANF work rules or in SNAP households subject to SNAP work rules.

Nebraska also adopted the short-term hardship exception. A month counts as met when a person is in a hospital, nursing facility, intermediate care facility or psychiatric inpatient stay; lives in a county under a presidential emergency or disaster declaration, or where unemployment is at least 8% or 1.5 times the national rate, whichever is lower; or must travel outside the community for an extended period for serious medical care. The state checks one month before an application and one month during each eligibility period at renewal, and gives people 30 days to respond to a noncompliance notice. DHHS said in June that existing members are phased in at renewal, starting with eligibility periods that ended July 31, 2026, and continuing through June 2027.

What comes next

Work requirements reach adult expansion enrollees in more than 40 states next year. KFF Health News reported that Democrats, who won both chambers of Congress, have said they plan to repeal H.R. 1's Medicaid changes in their first 100 hours in office in January, though President Donald Trump could veto a repeal. Related fights are already in court: a federal judge on Oct. 29 struck CMS's narrower "medically frail" test, and four states sued Nov. 5 to stop HHS from cutting their Medicaid funds over the rules. Georgetown's Center for Children and Families has identified Nebraska as the first state to activate hardship exceptions for disaster, emergency and high-unemployment counties, in 14 counties.

What this means for providers and DSPs

Most people with I/DD on waivers aren't the target, but their families may be. The rule reaches only the expansion adult group. A parent or relative who cares for a disabled family member at home and is enrolled through expansion should be excluded as a family caregiver, but only if DHHS knows it. Supports coordinators and family-support staff can encourage families to report that status before renewal.
Unanswered mail is the biggest risk. Most Nebraska denials came from no response, not from people failing the test. Agencies can remind families, and staff who help people open their mail, that notices carry a 30-day deadline.
Some frontline staff may be covered by expansion Medicaid. A DSP in the expansion group who works 80 hours a month, or earns about $580 a month, meets the requirement, but can still lose coverage by missing a verification request. HR teams can point staff to the DHHS work requirements page rather than give eligibility advice.
Facility stays count. Time in a hospital, nursing facility or ICF is a hardship event under Nebraska's plan, but people must request that exception themselves.
Budget extra time. With long waits at the DHHS call center, staff helping someone resolve a notice should plan for it to take more than one call.

Direct Support News will follow up as more states start the rules in January.