Human rights organizations said Thursday that Nebraska should be seen as a bright red warning sign of what’s to come for states across the US as they implement the draconian Medicaid work requirements included in the budget legislation that President Donald Trump signed into law last year.
In early May, Nebraska became the first state to implement the new work reporting mandates, which require certain Medicaid recipients to document at least 80 hours of work or other qualifying activities per month to remain enrolled in the program. Republican Gov. Jim Pillen, announced the state’s fast-tracked implementation of the requirements at a celebratory press conference late last year alongside Mehmet Oz, head of the Centers for Medicare and Medicaid Services.
Human Rights Watch (HRW), Oxfam America, and Nebraska Appleseed said in a joint report released Thursday that the rush to impose the mandates has had the predicted results of mass confusion and bureaucratic chaos, previewing what millions of Medicaid recipients across the country can expect in the months ahead.
“Nebraska is the canary in the coal mine for issues that most states will face when they begin implementing these work requirements,” said Matt McConnell, a US researcher on economic, social, and cultural rights at HRW. “As they do, they should make sure red tape doesn’t strip people of healthcare.”
The trio of advocacy groups interviewed a dozen Nebraskans who have directly experienced or witnessed the unruly rollout of the expanded work requirements. One 64-year-old man “said he lost his Medicaid coverage while undergoing treatment for kidney cancer and multiple chronic health conditions,” the groups noted.
“He said a representative of the health plan that managed his Medicaid coverage informed him he lost access because he was not working, even though he is unable to work due to his condition,” the groups added. The man said the loss of Medicaid coverage disrupted his care, including an appointment with a cancer specialist.
The Trump administration has said even people with terminal cancer are not necessarily exempt from the new work reporting requirements.
One Medicaid eligibility worker from the Nebraska Department of Health and Human Services told HRW, Oxfam, and Nebraska Appleseed that “poor training, vague and inconsistent guidance, and technical issues, including unprepared software systems, had caused stress and uncertainty for applicants and for state employees.”
“We just sometimes don’t know what we’re doing,” the worker said. “I wish the people who make policies knew what they were doing.”
It’s unclear exactly how many people have lost Medicaid in Nebraska as a result of the new requirements. Sarah Maresh, healthcare access program director at Nebraska Appleseed, said Thursday that obtaining data from the state has been “like pulling teeth.”
“Nebraskans deserve access to this information,” said Maresh. “You can’t fix problems you refuse to measure.”
Earlier this week, following relentless pressure from advocates, Nebraska’s health department released preliminary data showing that more than 1,000 Nebraskans have been deprived of Medicaid coverage due to the expanded work requirements—a figure that’s believed to be a significant undercount.
“I have been saying for years that Medicaid work reporting requirements are a flawed policy if the goal really is to incentivize work, but they are very effective at taking Medicaid coverage away by tangling folks up in red tape,” Joan Alker, executive director of Georgetown University’s Center for Children and Families, wrote in a blog post earlier this week. “Unfortunately, Nebraska’s data only reinforces this point.”
Nationwide, millions of people have lost Medicaid coverage since Trump signed the GOP budget package, which includes around $800 billion in cuts to Medicaid over the next decade.
States face a January 1, 2027 deadline to implement the expanded work requirements—though states are allowed to move more quickly. Montana and Arkansas have joined Nebraska in implementing the mandates ahead of the federal deadline, resulting in similar chaos and confusion.
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