Eli McCreary, 64, was diagnosed with kidney cancer in June. When a hospital called about his coverage, he was told Nebraska had dropped his Medicaid because he was not meeting the state’s new work requirement. He canceled a CT scan and put off appointments.
“I don’t understand what job I can get,” McCreary told KFF Health News. “I can’t walk. I can hardly breathe.” Nebraska is the first state to enforce the rule, and every other state must follow by Jan. 1 under the federal law President Donald Trump signed in July 2025.
That reaches Black families hard because they lean on public coverage. In 2022, nearly 40% of Black Americans under 65 were covered through Medicaid or another public plan, and 10% had no insurance at all, against 6.6% of white Americans.
Nebraska started May 1. By August, roughly 1,100 people had been denied benefits under the rule, and total enrollment had fallen by about 4,600, or 1.4%. About 70,000 adults in the state are subject to the requirement. The state budgeted $8.2 million over two years for contractors to run it, including Boston’s Public Consulting Group and Atlanta’s Covendis. Health advocates told the Nebraska Examiner the state hired no new staff and added no money for the computer systems that verify work.
The state disputes the picture. Jeff Powell, a spokesman for the Nebraska Department of Health and Human Services, said 86% of applicants met the requirement or qualified for an exemption, and 93% of existing enrollees kept their coverage. He said McCreary had “no lapses in coverage” and attributed the enrollment drop to people aging into Medicare.
The people in the remaining 7% are the story. Kenny McMorris, chief executive of Charles Drew Health Center, which serves about 13,000 patients a year in North Omaha, described who falls through. “If people are working, they just don’t have time to be sitting on the phone,” he said. Latanya Michaux of Public Consulting Group told KFF she “cannot brag enough about how well Nebraska handled this requirement.” An eligibility worker told Human Rights Watch: “We just sometimes don’t know what we’re doing.”
Human Rights Watch notes that six in 10 Medicaid recipients under 65 already work full or part time. The rule mostly catches people whose paperwork, phone call or exemption code did not go through. Advocates warn that a cancer patient who gets a flu check-up can be judged on the flu code instead of the cancer one.
Nationally, estimates run from 3 million to 7 million people losing coverage by 2028. That is a choice to pay contractors to police paperwork instead of paying for care, and it lands first on the communities with the most people on Medicaid and the least time to spend on hold. Democrats take control of Congress in January, and they can delay the rule or cut off money to enforce it. They should do it before the other states copy Nebraska’s rollout.
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