Effective May 1, 2026, Nebraska became the first state to enact Medicaid work requirements under H.R. 1. While states are required to implement work requirements effective January 1, 2027, Nebraska opted to implement early; as such, this is a valuable opportunity for states to learn lessons about Medicaid work requirements. Hilltop researchers Morgan Henderson, Danielle Barefoot, Leigh Goetschius, and Alice Middleton used publicly available, monthly enrollment data from The Centers for Medicare & Medicaid Services to examine the impact of work requirements in Nebraska. The authors find that the number of individuals determined eligible for Medicaid at application in Nebraska fell by 24.3% starting in May 2026, with an estimated monthly reduction of 1,265 new Medicaid enrollees. The impact in Nebraska is statistically significant and thus unlikely to have occurred by chance, and is also not observed in other states. Thus, this appears attributable to Medicaid work requirements.
This result aligns directionally with other early results from Nebraska but indicates that enrollment losses may exceed what has been reported by Nebraska. While data are still emerging, it will be crucial to use different data sources to holistically understand the impacts on affected applicants and enrollees.
See Nebraska Medicaid Work Requirement Analysis.
See more about Hilltop’s work on Medicaid work requirements.
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