Medicaid work requirements begin in Nebraska amid fears that many will lose coverage
Earlier this month, Nebraska became the first U.S. state to enact Medicaid work requirements under a new federal law. Health policy experts, including Harvard T.H. Chan School of Public Health’s Benjamin Sommers, are worried that many will lose coverage not because they’re ineligible, but because of cumbersome paperwork or confusing rules.
As part of the One Big Beautiful Bill Act passed by Congress last summer, Medicaid recipients across the nation will be required to document proof of employment, or reasons they should be exempted from work, starting in January 2027. Proponents of the measure have argued that it will cut fraud, waste, and abuse. But Sommers, Huntley Quelch Professor of Health Care Economics, is among experts who think the restrictions could hinder access.
According to a May 11 Marketplace article, policy groups have estimated that, in Nebraska, between 15,000 and 25,000 people could lose coverage, largely due to paperwork challenges. Sommers has studied previous state-level attempts to implement a Medicaid work requirement—such as one in Arkansas rolled out in 2018 in which 18,000 people lost coverage in seven months.
“There was no significant change in employment,” he said. He added, “I actually worry Arkansas isn’t the worst-case scenario. I think we are going to see some states that actually do worse than Arkansas.”
Sommers was also quoted in a May 18 Pennsylvania Capital-Star article about Pennsylvania’s efforts to implement Medicaid work requirements. He said that most adults on Medicaid who are capable of working already have a job—meaning that the work requirements may target less than 5% of enrollees. “More than 95% of folks are then having to go through all the verification to show that they’re already doing the things that we want them to do,” he said. He also noted other hurdles for people trying to meet the requirements, such as not knowing about them or not being sure if they applied to them.
Read the Marketplace article:
Nebraska becomes the first state to roll out Medicaid work requirements
Read the Pennsylvania Capital-Star article:
Pa. grapples with implementing Medicaid work requirements
Learn more:
Previous Medicaid coverage losses related to ‘unwinding’ shed light on what to expect from future cuts (Harvard Chan School news)
Medicaid work requirement is ‘a solution in search of a problem,’ says expert (Harvard Chan School news)
