Medicaid Work Requirements: Who Really Loses

Nebraska's data is in — and it confirms what researchers predicted: coverage losses hit working people, not the unemployed

Millions may lose Medicaid — not for being unemployed, but for paperwork.

Nebraska launched the country's first federally mandated Medicaid work requirements in May 2026. The early enrollment data is already telling a story that researchers predicted but policymakers chose to ignore.

📊 In the first month of implementation, the Nebraska Department of Health and Human Services reported that the majority of individuals losing coverage were not people who failed to meet the work hours threshold. They were people who failed to document that they met it. The administrative infrastructure required to verify work status — online reporting portals, documentation submission systems, monthly check-in requirements — is creating a compliance barrier that disproportionately affects the working poor rather than the unemployed.

This is exactly what the Arkansas data showed. When Arkansas implemented work requirements in 2018 before courts struck them down, employment rates did not increase. Coverage lo…