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H.R. 1 (the “One Big Beautiful Bill Act") was passed into federal law on July 4, 2025, and made many changes to the Medicaid program.
Starting May 1, 2026, members and applicants eligible under Medicaid expansion will have to meet work requirements to keep or get Medicaid coverage. Some people enrolled in Nebraska Medicaid through Medicaid expansion may not have to complete work requirement activities (see list of exemptions below).
Members with renewal dates in May or June 2026 will not have to show they've met work requirements until their renewal in 2027. Members can check their renewal date by logging into iServe.
Understanding Work Requirements
For an overview of the new Medicaid work requirements, please watch this video.
Do I have to meet Work Requirements?
If you're an able-bodied adult who is applying for or who already has Medicaid coverage through Medicaid expansion (also known as Heritage Health Adult), you must meet work requirements unless you have an exemption.
People enrolled through Medicaid expansion are Medicaid members who:
- Are between age 19 and 64
- Are not pregnant
- Do not have a disability
- Are not enrolled in Medicare
- Meet income limits (earn up to 138% of the federal poverty level or about $22,025 per year for one person or $45,540 for a family of four)
- Are U.S. citizens or meet immigration rules
Work requirements only apply to you if you are applying for or already have Medicaid coverage through Medicaid expansion. Some people may qualify for work requirement exemptions, including temporary hardships.
How do I know if I'm exempt?
Exemptions
You may not need to complete work requirement activities if:
- You are under age 26 and aged out of foster care
- You are a member of a federally recognized Native American tribe, an Urban Indian, a California Indian, or if you receive services through the Indian Health Service (IHS)
- You are a parent or caretaker of a child age 13 or younger
- You are caring for a person with a disability
- You are a veteran with a total disability rating
- You have a medical condition that prevents you from working. This can mean:
- You are blind or have a disability
- You have a substance use disorder
- You have a disabling mental health condition
- You have a serious or complex medical condition
- You have a serious physical, intellectual, or developmental disability
- You are in a household that gets supplemental nutrition assistance program (SNAP) or Temporary Assistance for Needy Families (TANF) benefits and are compliant under certain conditions with work requirements
- You are in a qualified drug or alcohol treatment program
- You are in jail or recently released (within 90 days of a qualifying month)
- You are pregnant or are up to 12 months postpartum (and you had Medicaid when you were pregnant)
Other mandatory exceptions may apply.
Temporary Hardships
You may not need to complete work requirement activities if:
- You were in the hospital or a nursing facility
- You or a dependent had to travel to receive serious medical care that wasn't available in your community
- You lived in a county under a federal emergency
- You lived in a county with a high unemployment rate (8 percent or 1.5 times the national unemployment rate)
If you were in the hospital, staying at a nursing facility, or traveling to get medical care, you will have to fill out a declaration form and sent it to DHHS. You can send the declaration form to DHHS online, over the phone, by mail, or in person.
If you lived in a county that was under a federal emergency declaration or in a county with a high unemployment rate, DHHS will check if either of these hardships apply to you. You don't need to complete a declaration form for living in a county under a federal emergency or with high unemployment.
How can I meet Work Requirements?
If you're an able-bodied adult who is applying for Medicaid or who already has Medicaid coverage through Medicaid expansion, and you don't have an exemption, you have to complete work requirement activities to get health coverage through Nebraska Medicaid.
Work requirement activities include:
- Working
- Attending school or an apprenticeship
- Participating in a work program
- Volunteering
You must spend at least 80 hours in at least one calendar month doing one of these activities or attending school or an apprenticeship at least half time. Or, you can combine any of these activities to get to 80 hours in a calendar month.
You can also meet work requirements if you are working and earn $580 in a calendar month. This is equal to 80 hours worked at the current federal minimum wage. You can also meet work requirements if your average monthly income from working over the last six months from seasonal work is at least $580, regardless of the number of hours worked.
See the "How Can You Meet Work Requirements?" One-Pager.
When do I have to meet Work Requirements?
Medicaid work requirements start on May 1, 2026. The review periods are different for people who already have Medicaid and people applying for Medicaid. The calendar month a member or applicant meets work requirements is known as a qualifying month.
For People Applying for Medicaid
If you apply for Medicaid on or after May 1, 2026, and you qualify for the Medicaid expansion group, the Medicaid work requirement review period is either the calendar month you apply or the calendar month before you apply.
If you are working, going to school, participating in a work program, volunteering, or earning at least $580, the work requirement review period is the calendar month before you apply. This means if you have 80 hours doing one of these activities, have 80 hours doing a combination of these activities, attend school half time, or earn $580 in the calendar month before applying for Medicaid, you will meet the work requirements.
If you qualify for a temporary hardship the work requirement review period is the calendar month before you apply. This means if you have a temporary hardship in the calendar month before applying for Medicaid, you will not need to complete work requirement activities.
If you qualify for an exemption the work requirement review period is the calendar month you apply or the calendar month before you apply. This means if you have an exemption in either of these calendar months, you will not need to complete work requirement activities.
For Existing Members
If you have Medicaid through Medicaid expansion, DHHS will check to see if you've met work requirements as part of your Medicaid renewal. Not everyone renews their Medicaid coverage at the same time.
DHHS will first start checking work requirements for members whose coverage periods end on or after July 31, 2026. Each member will be checked in their own renewal month over the next year.
If you're already on Medicaid, the work requirement review period is 12 months. This means you must complete work requirement activities, qualify for an exemption, or have a temporary hardship during at least one calendar month since your last renewal.
How do I show that I've met Work Requirements?
The Department of Health and Human Services (DHHS) will use information we already have to check if you already meet work requirements. If we can verify that you already meet work requirements, we'll send you an approval notice.
If DHHS does not have enough information to verify you meet work requirements, we will contact you to ask for more information. We'll send you a notice describing the information we need and a declaration form you must complete and return to DHHS. If DHHS requests additional information from you, you must submit the information within 30 days of getting the notice, or you may be denied or lose coverage. See examples of the notice and declaration form below.
You can respond to the notice and provide your information by:
- Scanning the QR code in your notice
- Visiting iServe online
- Mail
- Phone
- Visiting a local DHHS office in person
The most important thing to do is check your mail, email, and text messages regularly in case DHHS requests information. If DHHS does not send you a request, then you do not have to send additional information about work requirements.
Reporting Changes to DHHS
If you're a Nebraska Medicaid member, you must report changes that impact your eligibility. This can include changes in income, home address, work status, and household size (like marriage, divorce, pregnancy, or adoption). You can provide this information to DHHS in person, online, by phone, or through the mail.
If DHHS requests information from you or you need to report a change that affects your Medicaid eligibility, you can do it:
- Phone Number: (855) 632-7633 (press option 3)
- Lincoln Phone Number: (402) 473-7000 (press option 3)
- Omaha Phone Number: (402) 595-1178 (press option 3)
- TTY Number: (402) 471-7256
- Fax: (402) 742-2351
- In person: at a local DHHS office
Work Requirements Resources
- iServe Portal – Medicaid members and applicants can use iServe to submit Medicaid applications or renewals, check their benefits, view notifications from DHHS, and more.
- Job Seeking Assistance – The Nebraska Department of Labor has resources available online for people that need help finding a job.
Outreach and Educational Materials
Notices and Forms
- Nebraska Medicaid Work Requirements Outreach Notice / Spanish – DHHS is mailing this outreach notice to all Medicaid expansion members. DHHS is also emailing and texting Medicaid expansion members who opted in to receive electronic notifications.
- Verification of Compliance Notice / Spanish (Sample Notice) – DHHS will send this notice to an applicant or Medicaid member if we don't have enough information to confirm that they meet work requirements. The notice describes how the applicant or member can send the information we need and when they must send it by.
- Optional Screening Questions / Spanish (Sample Form) – People applying for Medicaid can complete these optional screening questions to provide information they think may help Nebraska Medicaid check if they've met work requirements. These questions may be available when applying on iServe or by mail from Nebraska Medicaid.
- Declaration Form / Spanish (Sample Form) – People applying for Medicaid or whose Medicaid eligibility is being reviewed may need to complete this form to declare they have completed certain work requirements or have certain exemptions. This form should only be used for declaring: volunteering, education or work programs, caring for a person with a disability, previous incarceration, medical exemptions, and VA disability ratings.
Medically Frail and SUD Treatment Exemption Information
- The following information explains how Nebraska Medicaid determines exemptions from work requirements for individuals who are medically frail or participating in a substance use disorder (SUD) treatment program. It outlines a process that uses available claims data when possible and allows individuals to self-declare when needed, minimizing administrative burden. The approach aligns with federal requirements while ensuring consistent, objective, and efficient eligibility determinations.
- Medically Frail and SUD Treatment Program Exemptions Process
- Medically Frail and SUD Exemptions Conditions Index
Community Presentations (videos)