Nebraska became the first state in the country to enforce the new federal Medicaid work requirement, on May 1, 2026. The requirement applies to non-exempt adults ages 19–64 in Nebraska’s Medicaid expansion program (Heritage Health Adult). Roughly 90,000 expansion adults are being tracked, and since August 2026 the state has been ending coverage for enrollees who didn’t report their hours about 200 people lost coverage in the first week alone, according to the state’s Medicaid director.
Last verified: September 20, 2026 ·
Quick Facts: Nebraska’s Work Requirement
| Fact | Detail |
|---|---|
| Enforcement start | May 1, 2026 — first in the nation, implemented through a state plan amendment |
| Who’s affected | Non-pregnant adults 19–64 in the Heritage Health Adult expansion program who don’t qualify for an exemption |
| The requirement | 80 hours/month of work, training, or qualifying community service; or half-time+ school; or monthly income of at least $580; or a combination |
| Where to report | ACCESSNebraska (the state’s online portal) or your local DHHS office |
| Verification | The state checks wage data and other records first; it contacts you only if the data can’t confirm your hours or exemption |
| Penalty | Notice + 30 days to respond; then coverage ends until you reapply and qualify |
| First disenrollments | Early August 2026 (~200 people in the first week) |
| Hardship exception | Nebraska adopted the high-unemployment county exception — currently no counties qualify |
What Nebraska Requires
Nebraska implements the federal standard created by the One Big Beautiful Bill Act and CMS’s June 2026 interim final rule:
- 80 hours per month of work (including part-time, gig, and self-employment), a state-approved work program, or qualifying community service — or any combination
- Or enrollment in school at least half-time (satisfies the requirement by itself)
- Or monthly income of at least $580
Volunteering counts only through a structured program run by a public or nonprofit organization that tracks your hours and can confirm them through a named contact.
Who Is Exempt in Nebraska
You are not subject to the requirement if you are pregnant or postpartum, caring for a child age 13 or under or for a person with a disability, medically frail or with special medical needs, an American Indian or Alaska Native eligible for IHS services, a former foster youth under 26, a veteran with a total disability rating, already meeting TANF or SNAP work rules, in a substance use disorder treatment program, incarcerated, under 19 or 65+, or enrolled in Medicare.
(Full exemption details and proof requirements: see our national guide.)
How to Report Your Hours in Nebraska
- Watch your mail and ACCESSNebraska account. Nebraska’s required outreach about the work requirement ran between June 30 and August 31, 2026 — if you never received anything, confirm your address with DHHS immediately.
- Log in to ACCESSNebraska and check whether the state already shows you as compliant or exempt (wage data matching comes first — many working enrollees won’t need to submit anything).
- Submit proof if asked: pay stubs, an employer letter, school enrollment verification, or a signed volunteer log.
- At renewal, be ready to show the months Nebraska asks for. Don’t wait for the notice to gather documents.
- If you get a noncompliance notice, respond within 30 days — in person, through the portal, or by calling DHHS. Nebraska is already disenrolling people who don’t respond.
What Happens If You Miss Hours in Nebraska
Nebraska is past the soft-launch stage — enforcement is live:
- The state reviews cases multiple times before ending coverage, per the Medicaid director
- You receive a notice and a 30-day window to demonstrate compliance or claim an exemption
- If coverage ends, you can reapply as soon as you can show 80 hours, the $580 income standard, or an exemption
- You have the right to appeal (request a fair hearing) if you believe the decision is wrong — don’t skip the appeal deadline printed on your notice
If coverage ends, you may qualify for ACA marketplace special enrollment — see our lost coverage guide.
Why Nebraska’s Numbers Matter
Nebraska is the first real-world test of the federal framework, and the early data previews what other states will face:
- ~200 disenrollments in the first week of enforcement (August 2026) a small number against ~90,000 tracked, but the pace depends on renewal cycles and will build
- The high-unemployment county exception is currently theoretical in Nebraska the state adopted it, but no county currently meets the unemployment threshold
- Arkansas’s 2018 precedent looms over the rollout: when Arkansas ran work requirements, roughly 18,000 people lost coverage and most were working or exempt tripped by reporting, not by inability to work
We update Nebraska’s disenrollment figures in the changelog as the state releases data.
FAQ
Yes. Nebraska became the first state to enforce the new federal work requirement on May 1, 2026. It applies to non-exempt adults ages 19–64 in Nebraska’s Medicaid expansion program (Heritage Health Adult).
Check ACCESSNebraska first the state verifies hours from wage data before asking you for anything. If the state can’t verify, submit proof (pay stubs, school schedule, or volunteer log) through the portal or your local DHHS office, and respond to any notice within 30 days.
You’ll receive a notice and have 30 days to show compliance or an exemption. If you don’t respond, your coverage can end — Nebraska began ending coverage in August 2026 for enrollees who missed their hours. You can reapply once you can document compliance.
Parents and caregivers of a child age 13 or under are exempt. If your youngest child is 14 or older, you’re subject to the requirement unless another exemption applies.
Sources
- Nebraska DHHS: Work Requirements
- KFF: An Early Look at Policy Decisions as States Get Ready to Implement Work Requirements
- CMS: Medicaid Community Engagement Requirement Interim Final Rule Fact Sheet
- Axios: Medicaid’s work requirement crunch arrives (Aug 3, 2026)
- KFF: The High Unemployment Hardship Exception
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