Nebraska Medicaid work requirements take effect, making it first state to enforce OBBBA mandate

Nebraska becomes the first state to enforce Medicaid work requirements under the One Big Beautiful Bill Act on May 1, 2026, eight months before the federal January 2027 deadline. About 72,000 Medicaid expansion enrollees ages 19-64 must work, attend school, participate in an approved training program, or volunteer for at least 80 hours per month or earn $580 — equal to 80 hours at federal minimum wage. Existing enrollees face enforcement starting at their next renewal beginning July 31. The Urban Institute projects 25,000 Nebraskans will lose coverage; the Center on Budget and Policy Priorities puts 28,000-41,000 residents at risk. Nebraska DHHS made no new staff hires for implementation and operates on a budget cut of $19 million. Advocates warn that eligible people will lose coverage through paperwork failures.