State’s Chaotic Rollout Foreshadows Risks as Nationwide Deadline Draws Near
(Washington, DC, October 1, 2026) – Nebraska’s efforts to implement new, federally mandated work requirements for Medicaid underscore fears that millions of people will experience avoidable barriers to healthcare coverage, Human Rights Watch, Oxfam America, and Nebraska Appleseed said today.
On May 1, 2026, Nebraska became the first state to implement work requirements for Medicaid, the public health insurance program for people with low- or no-income, as part of public spending cuts mandated by the Trump administration’s One Big Beautiful Bill Act (OBBBA), which also extended and deepened tax cuts that overwhelmingly benefit high-income households and corporations. These new rules will require most adults without dependents to document at least 80 hours per month of work, education, or other approved activities to maintain Medicaid coverage. States must implement the requirements by January 1, 2027, though they may do so sooner, as Nebraska has.
“Nebraska is the canary in the coal mine for issues that most states will face when they begin implementing these work requirements,” said Matt McConnell, U.S. researcher on economic, social, and cultural rights at Human Rights Watch. “As they do, they should make sure red tape doesn’t strip people of health care.”
Human Rights Watch and Oxfam America in August and September interviewed a dozen Nebraskans with personal or professional experience with Medicaid and a public employee involved in the process.
In a new issue brief out today, people interviewed said that the state’s rollout of new work requirements increased administrative burdens and risked disruptions in access to health care following the rushed implementation of these federal requirements. Data suggests that large numbers of people are already losing coverage in Nebraska because of the work requirements.
Eli McCreary, age 64 at the time, said he lost his Medicaid coverage while undergoing treatment for kidney cancer and multiple chronic health conditions. He said a representative of the health plan that managed his Medicaid coverage informed him he lost access because he was not working, even though he is unable to work due to his condition. “If I could work, I would work,” he said. “But I can’t…. I can’t walk around. I mean, I can’t breathe. I can’t walk very far.” The sudden lapse in coverage disrupted his planned care. “I was supposed to go see the cancer specialist here…. And that date was canceled, so I couldn’t. I had to wait until I got insurance again to even come back out here.... Everything was delayed.”
A Medicaid eligibility worker from the Nebraska Department of Health and Human Services said that poor training, vague and inconsistent guidance, and technical issues, including unprepared software systems, had caused stress and uncertainty for applicants and for state employees.
“We just sometimes don’t know what we’re doing,” the worker said, describing the rollout as rushed and confusing. “I wish the people who make policies knew what they were doing.”
The OBBBA, which became law in July 2025, imposed new eligibility criteria on the nearly 20 million adults without dependents in the 40 states and the District of Columbia who rely on expanded Medicaid coverage under the Affordable Care Act. Nebraska expanded coverage through a ballot initiative in 2018.
Adults in this expansion population will be required to prove that they either satisfy these new work requirements or qualify for a statutory exemption, including for caregivers of young children, pregnant people, certain people with disabilities, and those deemed medically frail. States may also choose to offer short-term hardship exceptions for certain individuals, such as those in counties with a federally declared emergency or disaster.
The Urban Institute estimated that between 3 and 7 million people in the United States could lose Medicaid coverage by 2028 because of these new requirements. The Congressional Budget Office, a nonpartisan government research agency, estimated that work requirements would increase the number of uninsured people in the United States by 4.8 million by 2034.
Nebraska Appleseed, a Lincoln-based nonprofit advocacy organization, has repeatedly requested data from the state regarding its implementation of these requirements. On September 29, 2026, Nebraska publicly released initial figures showing that over 1,000 people lost or were denied Medicaid coverage under the new requirements between May and August of this year. The number of people affected is likely to grow significantly over the coming months as state officials review enrollees’ eligibility on a rolling basis.
“Getting data from the state about how many people are losing coverage and why shouldn’t be like pulling teeth,” said Sarah Maresh, healthcare access program director at Nebraska Appleseed. “Nebraskans deserve access to this information. You can’t fix problems you refuse to measure.”
In May, Human Rights Watch and Oxfam America warned that millions of people were at risk of losing coverage due to the work requirements. In a joint letter to the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services (CMS), the organizations urged federal authorities to issue guidance for states that would help prevent these new federal requirements from causing harmful and unnecessary Medicaid denials and terminations. But CMS issued binding guidance on June 1 that will require burdensome case-by-case assessments.
“Federal authorities could have chosen to blunt the impact of the OBBBA’s inequality-fueling Medicaid cuts,” said Jackson Gandour, senior economic justice policy adviser at Oxfam America. “Instead, they added even more convoluted requirements that will deprive people of the healthcare they are entitled to.”
Under international human rights law, everyone has the right to the highest attainable standard of physical and mental health. Medicaid eligibility requirements already exclude people who earn too much to meet extremely low-income eligibility limits but not enough to afford private health insurance. Complex work reporting requirements may exclude millions more, undermining their rights to health, social security, and an adequate standard of living. Because the rules largely affect people with low incomes, these losses may also deepen inequality, the organizations said.
Officials in Nebraska and other states preparing to implement the work requirement provisions should identify ways to reduce administrative burdens and simplify eligibility assessments. Officials should also take steps to strengthen existing exemptions; improve communication about, and understanding of, who is subject to work requirements and who is exempt; and enhance transparency by regularly publishing data on application denials, coverage terminations, appeals, reinstatements, and the reasons underlying these decisions.
“Work requirements are a solution in search of a problem,” McConnell said. “The truth is that they make life harder for people who are already working or can’t work.”
/ENDS
notes to editor:
For details and further accounts by Medicaid recipients and staff, please see the accompanying issue brief, "Impacts of the OBBBA's Medicaid Work Requirements in Nebraska."
For more Human Rights Watch reporting on economic justice and rights, please visit: https://www.hrw.org/topic/economic-justice-and-rights
For more Oxfam America work on U.S. inequality, please visit: https://www.oxfamamerica.org/explore/issues/economic-justice/inequality-in-the-us/
For more information from Nebraska Appleseed on health care access, please visit:
https://neappleseed.org/healthcare
For more information, please contact:
For Human Rights Watch, in Oakland, Matt McConnell (English): +1-646-984-5417 (mobile); or [email protected]. X: @mcconnell_m
For Oxfam, in Washington, DC, Shelby Bolen (English): +1-949-677-3807 (mobile); or [email protected].
For Nebraska Appleseed, in Nebraska, Sierra Salgado Pirigyi: [email protected].