Nebraska Medicaid Work Requirements: What Changes and When

Nebraska became the first state to put Medicaid work requirements in place when the rules took effect on May 1, 2026. Federal law requires every state with Medicaid expansion to start by January 1, 2027, so Nebraska is eight months early. The first eligibility checks began this summer. Here is who is affected, what counts and what to watch if you or a parent is close to 65.

Who has to meet Nebraska's Medicaid work requirements?

The rules apply to adults ages 19 to 64 who are applying for or enrolled in Medicaid expansion, called Heritage Health Adult, and who are not enrolled in Medicare. Expansion covers adults with income up to 138% of the federal poverty level, which DHHS puts at about $22,025 a year for one person in 2026. DHHS counted nearly 70,000 expansion members in January 2026.

The rules do not apply to people on Medicare. That includes Nebraskans who get help through a Medicare Savings Program or full Medicaid through the aged, blind and disabled categories. If you are not sure which program covers you, our Medicare vs. Medicaid comparison lays out the differences.

The requirement comes from Public Law 119-21, signed July 4, 2025. Governor Jim Pillen and CMS Administrator Dr. Mehmet Oz announced Nebraska's early start on December 17, 2025.

What counts toward the 80 hours?

You meet the rule in a given month if you do any of these:

• Spend at least 80 hours on work, volunteering, school, an apprenticeship or a work program, or any mix of them
• Earn at least $580 from a job
• Attend school at least half-time
• Average $580 a month over six months, if your work is seasonal

For people applying, DHHS looks at the month you apply or the month before. For people already enrolled, you need at least one qualifying month since your last renewal.

Who is exempt?

DHHS lists these exemptions:

• Parents or caretakers of a child 13 or younger
• Caregivers for a person with a disability
• Pregnant women, or up to 12 months postpartum
• People with a medical condition that prevents work, including disability, blindness, a serious mental health condition or a substance use disorder
• People in a drug or alcohol treatment program
• Veterans with a total disability rating
• People meeting SNAP or TANF work rules
• Tribal members or people receiving Indian Health Service care
• Former foster youth under 26
• People released from incarceration within the past 90 days

DHHS also allows temporary hardship exemptions. These include a hospital or nursing home stay, traveling outside your community for serious medical care, or living in a county with an emergency declaration or high unemployment. DHHS posts the list of counties that qualify.

When will DHHS check, and what if you fall short?

Checks happen at renewal and are being phased in. Members who renewed in May or June 2026 will not be checked until their 2027 renewal. Checks began with eligibility periods ending July 31, 2026, and the phase-in runs through June 2027.

DHHS first tries to confirm you meet the rule from data it already has. If that is not enough, you get a notice and 30 days to respond with a declaration form or an exemption claim. You can respond by mail, by phone at (855) 632-7633, through iServe Nebraska or at a local DHHS office. If you don't respond or don't qualify, your coverage can end.

What else is changing for expansion members?

Federal law adds two more changes. Renewals every six months, instead of yearly, apply to expansion adults starting with renewals on or after January 1, 2027. We could not find DHHS guidance yet on how Nebraska will run them, so watch your mail. Cost sharing for expansion adults begins October 1, 2028.

What does this mean if you're 60 to 64?

Many early retirees bridge to Medicare on Heritage Health Adult. If you no longer work for pay, volunteering at church, a food pantry or a school can count toward the 80 hours, and caring for a spouse or relative with a disability can make you exempt. Our page on health insurance if you retire before 65 covers the other bridge options.

People enrolled in Medicare don't qualify for Heritage Health Adult, so plan the handoff early. Your Initial Enrollment Period starts three months before the month you turn 65. Our turning 65 checklist walks through the timing. If your income stays low, you may qualify for a Medicare Savings Program or a Dual Eligible Special Needs Plan.

Where do you apply or get help?

Medicaid applications and changes go through iServe Nebraska or DHHS at (855) 632-7633. For questions about Medicare and Medicaid together, Nebraska SHIP (formerly SHIIP) offers unbiased counseling at 1-800-234-7119. For Medicare's own costs this year, see 2026 Medicare costs at a glance.