Eli McCreary, residing in Omaha, Nebraska, learned from a hospital that his Medicaid benefits had been terminated and his upcoming medical appointments would face cancellation unless he paid out of pocket, all shortly after receiving a kidney cancer diagnosis.
The sudden termination of coverage highlights the immediate real-world fallout of Nebraska becoming the first state to enforce new Medicaid work rules under federal legislation. McCreary discovered he had lost his benefits when a representative at a local hospital informed him that staying enrolled required fulfilling mandatory work hours.
In Plain English: The Clinical Takeaway
- Eligibility Thresholds: The newly enforced federal rules require adult Medicaid recipients under specific Affordable Care Act provisions to prove they work or participate in qualifying activities for 80 hours a month.
- Exemption Criteria: Federal and state guidelines outline explicit exemptions for individuals who are medically unable to work due to serious conditions, severe illnesses, or active substance use disorders.
- Administrative Barriers: Processing delays, unsubmitted paperwork, and extended call center wait times frequently lead to coverage lapses for vulnerable patients managing complex diagnoses.
Nebraska Rushes Implementation of Federal Work Rules
Nebraska rolled out the new regulations on May 1—skipping ahead of most other states by eight months—in a bid to become the inaugural state implementing Medicaid work mandates tied to President Trump’s signature One Big Beautiful Bill Act.
State officials defended the swift deployment. Jeff Powell, a spokesperson for Nebraska’s Department of Health and Human Services, stated that the rollout had been very successful. Powell pointed to state data indicating that 86% of affected applicants met the requirement or qualified for an exclusion, while 93% of existing enrollees maintained their coverage.
However, health clinics and advocacy organizations reported widespread confusion, inadequate staffing, and poor training during the transition. Sarah Maresh, a program director with the social justice advocacy nonprofit Nebraska Appleseed, criticized the reliance on costly private contractors. State public records obtained by KFF Health News showed that Nebraska budgeted $8.2 million over two years for firms like the Public Consulting Group and Covendis to support the administrative rollout.
Diagnostic Delays and Systemic Confusion for Patients
McCreary’s medical history includes diabetes, chronic obstructive pulmonary disease, and a battle with drug addiction that ended when a treatment program discharged him in March. In June, physicians diagnosed him with cancer in his right kidney. Following the hospital’s notification that his insurance was gone, McCreary canceled a scheduled CT scan and delayed an appointment with a traveling specialist.
Attorneys and policy professionals specializing in public benefit programs noted that McCreary’s four-month substance use treatment program starting in November 2025, alongside his severe physical limitations, should have qualified him for a medical exemption. McCreary stated that his physical decline made employment impossible. He noted that he could barely walk or breathe.
Internal health department documents revealed that as of early July, the majority of Medicaid denials related to work requirements among adult applicants stemmed from unsubmitted paperwork. State data also showed that average wait times at the AccessNebraska call center nearly doubled between May and July, climbing from about 13 minutes to 26 minutes before dropping in August as call volumes surged past 101,000.
Work Requirements Will Expand to 40 States Next Year
The situation in Nebraska serves as a preview for upcoming nationwide changes. Next year, work requirements will apply to millions of adult Medicaid enrollees in more than 40 states.
Democrats intend to reverse the alterations made to Medicaid during their initial 100 days holding congressional majorities this coming January.
