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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 Nebraska Medicaid will begin enforcing work requirements for new applicants and existing Medicaid members under Medicaid expansion. Some people enrolled in Nebraska Medicaid through Medicaid expansion may not have to complete work requirements (see list of exemptions below).
What is Medicaid Expansion?
Medicaid expansion includes people who are aged 19-64, have a low income, and get their health insurance through Nebraska Medicaid (also known as Heritage Health). They cannot get Medicare, and they cannot be pregnant or be eligible on the basis of a disability. They also must be a U.S. citizen or meet Medicaid immigration rules. Low income means people who earn up to 138 percent of the federal poverty level (about $21,610 per year for a single person, or $44,380 for a family of four).
What are Work Requirements?
Work requirements are activities Medicaid members and applicants under Medicaid expansion must complete to get health insurance through Nebraska Medicaid.
Work requirement activities include:
- Working
- Attending school or an apprenticeship
- Participating in a work program
- Volunteering
Medicaid members and applicants must spend at least 80 hours in at least one qualifying month doing one of these activities or attending school or an apprenticeship at least half time. Or Medicaid members and applicants can combine any of these activities to get to 80 hours during a qualifying month.
Individuals can also meet work requirements if they are working and earn the federal minimum threshold in a qualifying month. This is the equivalent of 80 hours worked at the current federal minimum wage. As of December 2025, this is about $580 per month.
When do Work Requirements Start?
Work requirements take effect on May 1, 2026. This includes people with Medicaid coverage under Medicaid expansion on this date or people who apply on or after this date.
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Reporting Work Requirement Information
The Department of Health and Human Services (DHHS) will examine Medicaid members' case information to determine if they have met work requirements in a qualifying month or if they qualify for an exemption.
If DHHS does not have enough information to verify work requirements or an exemption, we will contact the individual and ask for more information. We will send the individual a form describing the information we need from them and how they can send it to us. If DHHS requests additional information from a member, they must submit the requested information within 30 days of receipt, or they may lose their Medicaid coverage.
Medicaid members should check their mail or email regularly in case DHHS requests more information from them. If a Medicaid member does not receive a request from DHHS, then they do not have to send additional information.
Exemptions
Some Nebraska Medicaid expansion adults may not need to complete work requirements if they meet one of the following exemptions:
- People under age 26 who aged out of foster care
- People who are members of recognized Native American tribes
- Parents, caretakers or guardians of children up to age 13 or of an individual with disabilities
- Veterans with a total disability rating
- People who are medically frail or have special medical needs, including:
- Blindness or disability
- Substance use disorder
- Disabling mental disorder
- Or other significant physical, intellectual or developmental disabilities
- People compliant with work requirements under the SNAP or TANF programs
- People who are participating in a drug addiction or alcoholic treatment program
- People who are incarcerated or have been incarcerated within the last 90 days
- Women who are pregnant or up to 12 months after the end of pregnancy
Other mandatory exceptions may apply.
DHHS will try to use information it already has available to see if members and applicants qualify for one of the exemptions listed above. If DHHS does not have enough information, we will contact the individual to ask for more information.
Temporary Hardships
Some people enrolled in Nebraska Medicaid through Medicaid expansion also may not need to complete work requirements if they have one of the following temporary hardship reasons:
- People who were hospitalized or lived in a nursing home since their last coverage renewal.
- People or a dependent who had to travel outside their community to receive care to treat a serious health condition since their last coverage renewal.
- People who lived in a county that was under an emergency declaration or in a county with a high unemployment rate since their last coverage renewal.
Members and applicants who have one of these temporary hardship reasons may need to make a request to DHHS in person, online, by phone, or through the mail.
Reporting Information to DHHS
Nebraska Medicaid members must report changes that impact their eligibility. This includes changes in income, home address, work status, and household size (such as 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 an individual or they need to report a change that affects their Medicaid eligibility, they can do so in the following ways:
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Online: at
https://iserve.nebraska.gov/
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By mail: P.O. Box 2992
Omaha, NE 68103-2992 -
By phone:
- 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
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In person: at a
local DHHS office
Work Requirement Resources