Nebraska enforces the first Medicaid work requirements under the OBBBA, eight months ahead of the federal deadline

Nebraska began enforcing Medicaid work requirements on May 1, 2026, requiring expansion enrollees to document 80 hours per month of qualifying activity to retain coverage — eight months before the January 2027 federal deadline set by the One Big Beautiful Bill Act. About 72,000 Nebraskans are subject to the new rules, implemented through a state plan amendment rather than a Section 1115 waiver. The Urban Institute projected enrollment would decline by 16,000 to 30,000 people by 2028, primarily through administrative failures rather than actual non-compliance.