Nebraska became the first state to tie Medicaid coverage to work this year, and its own numbers now show what that looks like in practice: 1,090 people were denied coverage or lost it under the new rules by the end of August.
Most of them were not turned away for failing to work. They were turned away because a request for information went unanswered, a pattern that matters well beyond Nebraska, since every state has to start the same requirement on January 1, 2027.
What Nebraska’s own figures show
The numbers come from the state Department of Health and Human Services, which presented them to Nebraska’s Medicaid Advisory Committee on September 17. The draft minutes of that meeting break the results into two groups.
Among new applications processed from May through August, 557 were denied for reasons tied to the work requirement. Of those, 466 were marked “not responsive,” meaning the applicant did not answer the state’s request to verify their status, and 91 were found non-compliant.
Among existing members whose coverage came up for renewal in July and August, 533 lost it under the requirement. Here the split was even more lopsided: 490 were not responsive, and 43 were found non-compliant.
Added together, that is 1,090 people. Of them, 956 were cut off over a missing response, and 134 were found not to meet the rule.
Inside the organizer: The new Medicaid work requirement and who is exempt, set beside a renewal and reporting calendar, covers the exact two pieces Nebraska’s denials turned on, the activity rule and the verification request with a reply window. Both are laid out in The SNAP & Medicaid Renewal Organizer.
Most people who were checked kept coverage
The same minutes show that the large majority of people who went through the process stayed covered. Of 7,280 renewals processed, 6,747 were approved. Of those, 2,449 people met the work or income test, 4,171 qualified for an exemption and 127 received a temporary hardship exception.
Exemptions did much of the work. Among renewals, 1,612 people were exempt as medically frail and 1,307 as caregivers.
The application side was messier. Of 9,614 applications processed, 4,991 were denied, but only 557 of those denials were connected to the work requirement. The other 4,434 were denied for other reasons, which the state’s summary does not break down. The draft minutes record a note of caution about reading too much into four months of data: “It’s too early to determine trends in the data.”
Who has to meet the rule in Nebraska
The requirement applies to adults ages 19 to 64 covered through Medicaid expansion, which Nebraska calls Heritage Health Adult, according to the state’s work requirements FAQ. To fall under it, a member must not be pregnant, must not have a disability and must not be enrolled in Medicare.
Members can meet it by working at least 80 hours a month or earning at least $580 in a calendar month. Half-time enrollment in school or a registered apprenticeship counts, as do organized job-training programs and community volunteering.
The FAQ lists exemptions for parents and caretakers of children under 14, people with disabilities or serious medical conditions, pregnant women through 12 months postpartum, American Indians and Alaska Natives, veterans with a total disability rating, and young adults under 26 who aged out of foster care.
Why a missed letter costs coverage
The state checks existing data first. When that is not enough, DHHS sends a notice, and the FAQ says members must respond within 30 days. Failing to respond, or failing to meet the requirement, leads to denial or termination.
Getting coverage back is not a matter of answering late. The FAQ says a person who loses Medicaid under the requirement has to meet it and then submit a new application. Responses and applications go through the state’s iServe Nebraska portal, and the state’s help line is (855) 632-7633, option 3. More detail is posted on the department’s work requirements page.
That is the mechanism behind the 956 figure. A household that moved, missed the mail, or did not realize a renewal letter required a reply could be eligible on paper and still lose coverage.
The national version starts in January
Nebraska moved early. The 2025 federal budget reconciliation law requires states to condition Medicaid eligibility for adults in the expansion group on work or related activities starting January 1, 2027, according to a KFF analysis of Nebraska’s early results published September 29.
Analysts at Georgetown University’s Center for Children and Families reached the same 1,090 total and argued that procedural denials, not work status, are driving the losses. Their reading and the state’s caution point to the same practical lesson. In Nebraska, the paperwork step decided far more cases than the work test itself, and other states will be running the same step at much larger scale in a few months.
A verification letter with a short clock
Of the 1,090 Nebraskans shut out under the work rule, 956 never answered the state’s verification request, and Nebraska’s FAQ says the reply window is 30 days with a new application required afterward. The figures show the gap is not the work test but the reply, and the January 1 national start puts the same letter in front of expansion adults in every state.
The SNAP & Medicaid Renewal Organizer covers the new Medicaid work requirement and who is exempt, a renewal and reporting calendar and 51 state packs, so the date a notice arrived and the date a reply went back are written down in one place.
See the work-rule exemptions in The SNAP & Medicaid Renewal Organizer.
This article was created with AI assistance and reviewed for accuracy against Nebraska Department of Health and Human Services documents.
Elias Broderick specializes in residential and commercial real estate, with a focus on market cycles, property fundamentals, and investment strategy. His writing translates complex housing and development trends into clear insights for both new and experienced investors. At The Daily Overview, Elias explores how real estate fits into long-term wealth planning.
