MEDICAID Expansion Work Requirements

Under a new law passed by Congress and signed by President Trump, Nebraska Medicaid expansion enrollees will have to meet work requirements or prove an exemption to get coverage. Governor Pillen is starting these requirements 8 months early on May 1, 2026.

Medicaid expansion is a specific type of Medicaid that provides health coverage to 70,000 Nebraskans between the ages of 19-64 who have income up to 138% of the federal poverty level (in 2026, about $22,000/year for an individual) and do not qualify for any other type of Medicaid.

Work Requirement Details

When does This Start?

• New applicants: Starting May 1, applicants who would qualify for Medicaid expansion must meet or prove an exemption to work requirements. 
• Existing enrollees: Starting May 1, DHHS will begin to assess anyone with renewals due on or after July 31, 2026 for work requirements. During this time, DHHS may contact you for more information.

Who is exempt?

There are multiple kinds of exemptions.

• Some exemptions, sometimes called “mandatory exemptions” include people who are pregnant, are under the age of 26 and aged out of foster care, members of a federally recognized Native American tribe, an Urban Indian, a California Indian, or people who receive services through the Indian Health Service (IHS),  parents/guardians of a child under 14 or a person with disabilities, are medically frail (including blindness or disability, substance use disorder, disabling mental health conditions, serious or complex health conditions, or have a serious physical, intellectual, or developmental disability), are a veteran with a total disability rating, some people in households that get supplemental nutrition assistance (SNAP) or Temporary Assistance to Needy Families (TANF), in a qualified drug or alcohol treatment program, or currently incarcerated or were incarcerated within the last 90 days. Other exemptions also apply.
• Other exemptions, sometimes called “short-term hardship exemptions” include situations like being hospitalized or in a nursing facility, traveling outside of your county for health care for yourself or a dependent, or being in a county with high unemployment or a federal emergency.

How do you meet requirements?

If you must meet work requirements, you generally must complete at least 80 hours of qualifying activities in a qualifying month (but not every month, see more details below). This may include full or part-time paid work, self-employment, a work program, school (at least half-time), or volunteering, among other things. 

A qualifying month can be different depending on whether you are a new applicant or completing your renewal. It can also be different depending on whether you are meeting the requirements or qualify for certain types of exemptions (see above for descriptions of “mandatory” and “short-term hardship” exemptions).

	Activities & Exemptions	Starting Date	Qualifying Months
New applicants	Qualifying activities or short-term hardship exemptions	May 1, 2026	Month before month of application  Example: If applying in May 2026, need qualifying activities (work, school, etc.) or short-term hardship in April
	Other exemptions (not short-term hardship)	May 1, 2026	Month of application or the month before Example: If applying in May 2026, exemption in April or May
Enrollees	Any activities or exemptions	For Medicaid cases due for renewal on or after 7/31/26, DHHS will start to check your case on May 1, 2026	Any one month in your renewal period. In 2026, renewals are usually every 12 months (i.e., if your renewal is due July 31, 2026: DHHS will be checking whether you have any one month with qualifying activities or an exemption since your last renewal which was probably August 1, 2025). Starting in 2027, renewals will be every six months.

The work requirements are complicated. Stay up to date by subscribing to the Nebraska DHHS Work Requirements website.

Resources

• Medicaid Work Requirements Informational Postcard
• Medicaid Work Requirements Frequently Asked Questions (FAQ)
• HCAN Flow Chart: Medicaid Work Requirements: Does this apply to me?
• Nebraska DHHS Medicaid Website – subscribe to receive updates

Get Local Help

• For general information, referrals and/or help navigating questions or issues with the process contact Nebraska Appleseed Community Assistance Line neappleseed.org/gethelp
• For free assistance with Medicaid applications or existing coverage contact an assister at a local community health center: howtogetcare.org/find-a-navigator/
• For legal assistance appealing an eligibility determination:
  • Legal Aid of Nebraska legalaidofnebraska.org or 1-877-250-2016
  • nefindalawyer.com
  • ne.freelegalanswers.org

Medicaid Expansion is a lifeline for Nebraskans

Work Requirements Don’t Work: This new policy is harming Nebraskans

70,000+ Nebraskans will be subject to Medicaid work requirements. But even more are being impacted. 

In March 2026, “Jane,” a mom in Lincoln, was erroneously told by a DHHS worker that she was going to lose Medicaid because the worker believed she wouldn’t meet the work requirements or an exemption. She scheduled a major medical procedure because she thought she would have no health care coverage. After spending more than an hour on the phone with multiple DHHS workers and her lawyer, she ultimately found out that she is not in the expansion category, so the work requirements don’t even apply to her.

Want to share your experience or get involved?
Email Freedom at fthompson@neappleseed.org.