Get to know the Medicaid expansion waiver: work requirements

What is the Medicaid expansion waiver? Why are work requirements problematic?

Last November, Nebraskans passed Initiative 427, expanding Medicaid to adults who make up to 138% of the Federal Poverty Level (about $17,000 a year for an individual). Instead of honoring the vote and promptly starting the program, the Nebraska Department of Health and Human Services (DHHS) is intentionally seeking to delay Medicaid expansion until October 2020 and has chosen to spend significant resources to pursue approval of an unnecessary and complicated Medicaid expansion plan, known as a Section 1115 Waiver. The proposed Section 1115 Waiver imposes barriers and cuts to health care coverage, none of which were authorized by voters. As part of the Section 1115 Waiver, DHHS is seeking to require people in the Medicaid expansion group to meet work requirements to be eligible for certain Medicaid benefits, despite the potential negative impacts on Nebraskans.  

DHHS’ Proposed work requirement:

DHHS’ proposed a two-tiered benefit system outlined in their Section 1115 Waiver Concept Paper, which creates two levels of coverage for people covered by Medicaid expansion: 

  • Prime Coverage provides the same benefits that people who currently have Medicaid receive.
  • Basic Coverage eliminates coverage for dental, vision, and over-the-counter drugs. 

To receive Prime Coverage, a person will have to meet work requirements by either: (i) being employed, actively participating in job seeking activities through the state, attending a post-secondary school or apprenticeship, or actively engaged in volunteer activity for a public charity for at least 80 hours a month; or (ii) being a caretaker relative.

Work requirements are legally suspect, expensive, and impose unnecessary burdens. 

Work requirements are legally suspect. Work requirements have been struck down in three of the four states that have implemented work requirements, and a lawsuit challenging work requirements in the fourth state was recently filed in federal court. The court has indicated that federal approval of work requirements was invalid because they have not addressed how work requirements are related to “thecore’ objective of Medicaid: the provision of medical coverage to the needy.” 

Implementing work requirements will increase state administrative costs. Work requirements will require logging, tracking, and verification by DHHS, which will require significant upfront and ongoing costs and will be costly to implement

Most Nebraskans in the Medicaid expansion group are already working. Most Nebraskans that will benefit from Medicaid expansion are already working in jobs that Nebraskans rely on every day, such as food service, construction, and office and administrative support, and most that are not working report barriers that prevent them from working. While health care coverage helps people work and gain financial stability, studies indicate that work requirements do not significantly increase employment.  

Work requirements could cause individuals to lose coverage. Evidence suggests that requiring individuals to comply with reporting work requirements is burdensome and can be a barrier to accessing coverage and care, even if people are already working. If work requirements are not properly and timely reported, people in the expansion group could lose Prime Coverage.   


Do Not Waiver. Stand for Expansion. DHHS is holding the following public hearings on their Section 1115 Waiver across the state: 

  • Scottsbluff on October 29;
  • Kearney on October 30;
  • Norfolk on November 7; and 
  • Omaha on November 12.  

Attend a public hearing and/or submit a comment on DHHS’ Section 1115 Waiver, demanding that they abandon their unnecessary Section 1115 Waiver efforts and immediately open enrollment for Medicaid expansion. 

If you would like to share a personal story about why Medicaid expansion is important to you, contact us at

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