On May 1, Nebraska is prematurely implementing Medicaid work-reporting requirements, ahead of the federally mandated January 1, 2027, implementation date for states, according to a news brief from the health advocacy organization Families USA. Work-reporting requirements may cause thousands of low-income individuals – including those who are already working or qualify for exemptions – to lose health coverage.

“Prior states’ efforts to implement similar work reporting requirements resulted in widespread coverage losses and increased financial burdens on states and providers, all while employment rates remained stagnant,” Mary-Beth Malcarney wrote in a blog post for Families USA. “Under H.R. 1, beginning in 2027, all states must require adults enrolled in the ACA’s Medicaid expansion to either demonstrate they are engaged in at least 80 hours per month of work or other community engagement activities, or document they meet one of several exemptions under the law,” Malcarney explained.

In Nebraska, Malarney stated that these requirements will impact over 70,000 low-income individuals, most of whom are already employed or qualify for community engagement exemptions. Researchers project that 28,000 to 41,000 Nebraskans will lose coverage once the requirements are implemented.

Today, April 29, Families USA, Nebraska Appleseed, and American Cancer Society Cancer Action Network (ACS CAN) hosted a virtual press call to emphasize how this decision to accelerate implementation could jeopardize the health of Nebraskans.

“Last year, the current Congress and President Trump made healthcare cuts of over $1 trillion to Medicaid and the marketplaces that would push and price people out of both public and private coverage,” Families USA executive director Anthony Wright remarked. “A major part of the massive Medicaid cuts made, the biggest in the program's history, are new bureaucratic barriers that will make it harder for millions of Americans to get on and stay on coverage.”

“We've heard directly from Nebraskans who say that Medicaid expansion has saved their life,” said Sarah Maresh, access program director with NE Appleseed. “We have 70,000 Nebraskans who are enrolled in Medicaid expansion right now and are going to be switched to the work requirements.”

“When we have a rush job, we unfortunately usually see bad results, and this is shaping up to be the case in Nebraska as well,” Maresh noted. She mentioned that there has not been sufficient outreach and that many people don’t know this is coming. Literacy levels need to be considered, she explained, in light of accessibility concerns. Furthermore, she said, website maintenance has hindered people from finding the information they need, and staff who are not properly informed have furthered misinformation.

Another issue, Maresh explained, is that people don’t know whether they have advanced coverage. It’s not on their notice and not on their portals. They would have to call DHHS, which is already overloaded with calls from people trying to find out whether this new requirement will affect them.

“ACS CAN believes that the state should be making it easier for people to access healthcare coverage, rather than making it harder, remarked Megan Word, government relations director with ACS CAN. “Instead, what we're seeing is the state rushing to implement new Medicaid work requirements, choosing to add more red tape and bureaucracy on Nebraska's most vulnerable citizens, including cancer patients. And they're doing it long before the federal government is requiring it.”

“Research has long shown that those people covered by health insurance are more apt to receive timely cancer preventative services, early detection tests, active treatment, and follow-up care,” Word underscored. “All of those factors improve cancer outcomes and the likelihood of surviving a cancer diagnosis. To put it plainly, when it comes to cancer, health insurance can mean a matter of life or death….The idea that unnecessary barriers and red tape are being put into place for people in order to access that healthcare coverage is unacceptable.”

“Most adults to whom these new work requirements will apply will be eligible for important, recommended cancer screenings and preventative services like mammograms and colorectal screenings, making it harder for Nebraskans to access these, and these screenings mean that there will be more suffering from cancer and more cancer deaths in the state of Nebraska,” Word explained.

Furthermore, Word said, people who are undergoing cancer treatment often have to step back from work. This would mean they could not meet the work requirement rule. “Now, under Nebraska's Medicaid program, it could mean that cancer care is interrupted or terminated….No one should be denied health insurance because they become too sick to work.”