Nebraska became the first state on Friday to implement the federal Medicaid work requirements, mandated under President Donald Trump’s tax and spending bill that passed last summer.
The bill imposes new 80-hour per month work requirements on able-bodied Medicaid recipients aged 19 to 64 who don’t have dependents. These requirements include working or other approved activities, such as school and volunteering.
There are exemptions for certain groups, such as parents or guardians of children under age 14 and those with disabilities.
Estimates from the Congressional Budget Office (CBO) suggest approximately 5.2 million Americans nationwide could lose Medicaid coverage by 2034 due to these new work requirements. The CBO estimated the federal policy would increase the number of people uninsured by 4.8 million.
A report from the nonpartisan policy research group Center for Budget and Policy Priorities found that 28,000 to 41,000 Nebraskans are at risk of losing coverage by 2034 following the implementation of work requirements. (this should be higher with the Nebraska mention) Will move up
Health policy experts told ABC News that sharp Medicaid cuts could result in vulnerable Americans, in Nebraska and nationwide, no longer being able to receive care, either by losing coverage or by closing the centers that provide such care.
Medicaid website.
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“People should be aware of what’s going to happen to their neighbors … the people who clean their houses, the people that pick their crops. These are the people who are about to lose their health care,” Sara Rosenbaum, professor emerita of health law and policy at George Washington University’s Milken Institute School of Public Health, told ABC News. “It’s not just the health care effects; it’s the health effects. What will happen is people with serious conditions, and chronic health conditions especially, will go untreated and unmanaged.”
She added, “What you’ll also have in the lower-income population is a broad-based health deterioration. I mean, this is a public health catastrophe as well as an economic catastrophe.”
Loss of coverage
The megabill will cut Medicaid by more than $900 billion, the largest cut in the program’s history, according to the CBO.
Republicans said their goal with Medicaid cuts is to reduce “waste, fraud, and abuse,” saving hundreds of billions of dollars over the next decade and to pay for Trump’s tax cuts and increased funding for the border and defense.
The bill also requires states to conduct eligibility redeterminations at least every six months for all recipients instead of the current 12 months, prohibits states from using their funds to cover undocumented immigrants and increases required Medicaid paperwork for income and residency verification.
House Speaker Mike Johnson, a Republican from Louisiana, defended the work requirements as “common sense.”
“You’re telling me that you’re going to require the able-bodied, these young men, for example, to only work or volunteer in their community for 20 hours a week. And that’s too cumbersome for them?” Johnson told NBC News’ “Meet the Press” last year. “I’m not buying it. The American people are not buying it.”
In a Facebook post on Friday, Republican Nebraska Gov. Jim Pillen celebrated the new requirements saying, “Welfare should be a hand up, not a hand out, and this will encourage able-bodied adults to join the workforce — and ultimately help these folks know that their contributions to our state make a difference.”
However, as of early 2026, about two-thirds of non-elderly, non-disabled adult Medicaid enrollees in Nebraska work or attend school, according to KFF, a non-profit organization that focuses on health policy research and polling.”
“It’s reported to solve a problem that doesn’t exist … and the government then only makes things worse,” Rosenbaum said. “And that’s what’s happening here. There is no problem with poor people working. I don’t know how the lawmakers who supported this bill think that poor people are able to live if they’re not working.”
In this March 19, 2025, file photo, the Centers for Medicare & Medicaid Services building is shown in Woodlawn, Maryland.
Kayla Bartkowski/Getty Images, FILE
Experts told ABC News that some people will be at risk of losing coverage due to cumbersome red tape and may have trouble providing proof of work or schooling including middle-aged adults or those whose native language isn’t English.
“Someone whose job hours are changing, someone who’s got multiple jobs or is in the gig work, whereas they’re going to have more difficulty demonstrating what they’re doing,” Dr. Benjamin Sommers, a professor of medicine at Harvard Medical School, told ABC News.
The White House and the Department of Health and Human Services did not immediately reply to ABC News’ request for comment on experts’ fears about how many Americans may lose coverage due to the new requirements.
Effect on rural hospitals, community centers
Experts told ABC News they are worried that cuts to Medicaid could force rural hospitals and community health centers in Nebraska to close.
Although Trump’s tax and spending bill included a $50 billion rural health stabilization fund, it is unclear if that will be enough to prevent medical centers from closing.
Many rural health care centers receive revenue from patients covered by Medicaid and losing that revenue could be costly.
“As a doctor, my first concern goes to the patients who are gonna lose coverage and become uninsured and have difficulty affording care, but there are also a lot of other groups that are gonna be harmed by this,” Sommers said
