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Nebraska Medicaid and the new work rules
Nebraska Medicaid covers adults 19-64 through Heritage Health Adult, the voter-approved expansion group, at up to 133% of the federal poverty line under the state's own income table (138% once the standard 5% income disregard is applied). Parents and caretaker relatives who are not in the expansion group have a far lower separate limit of 58% FPL. There are also aged, blind, and disabled pathways. is run by Nebraska Department of Health and Human Services (DHHS), Division of Medicaid and Long-Term Care (MLTC). Nebraska expanded Medicaid on October 1, 2020, which is why the new federal work requirement reaches this state — and why what you do now matters.
From May 1, 2026, most adults have to show 80 hours a month
The requirement applies to adults aged 19 to 64 covered through Medicaid expansion — around 69,678 people in Nebraska. It is not only about paid work: study, job training, volunteering and a mix of them all count , and earning at least $580 a month satisfies it on its own.
DHHS runs an ex parte review first — it checks data it already holds, and if it can confirm compliance it simply sends an approval notice and asks the member for nothing. About 90 days before a member's eligibility period ends it also scans medical claims for diagnosis and procedure codes indicating a medically frail condition, and deems those members exempt without any action on their part. Where the data is not enough, DHHS mails a Verification of Compliance notice with an Individual Declaration Form. The member has 30 days from receipt to respond, with 5 days of mail time built in and the actual due date printed on the notice, and can respond online through iServe, by scanning a QR code on the notice, by mail, by phone, or in person at a local DHHS office. The declaration form is used for volunteering, education and work programs, caring for a person with a disability, prior incarceration, medical exemptions and VA disability ratings; no supporting documents such as health records or a doctor's note are required, but the form is signed under penalty of perjury. Application and renewal forms now carry optional screening questions that help DHHS verify compliance up front; answering them is voluntary and will not slow processing, though leaving information out can. Once DHHS confirms one qualifying month, the member is treated as compliant for the whole eligibility period. DHHS projected it would be able to confirm activities or exemptions from existing data for 60-72% of the roughly 70,000 expansion members, and would have to request documents from the remaining 28-40%, or 20,000 to 28,000 people.
If your hours swing from month to month, say so. The rule is written per month, which is the wrong shape for farm and fishing work, construction, tourism and seasonal retail — a good month and a dead month average out to a living, but the dead month is the one that fails. Federal law has a provision for exactly this: a seasonal worker can satisfy the requirement using their average monthly income over the previous six months instead of hours worked in the month being checked. It is at 42 CFR 435.552(a)(7), and the law defines who counts as seasonal by pointing at the tax code rather than listing jobs, so do not decide for yourself that it misses you. If your work is seasonal or your hours are irregular, tell the state that when you report, and ask for the six-month average to be used.
You do not have to prove anything if any of these describe you
Exemptions are meant to be applied by the state automatically from records it already holds, but records are imperfect. If one of these fits you and you still get asked to report hours, say so and ask them to check — don't assume the notice is right.
What you can earn and still qualify
Monthly income, before tax, for the whole household. These are the state's own published figures, which is what its caseworkers actually apply. If you are close to a line, apply anyway — some income does not count, and only the agency can run the calculation for your situation.
Adults 19 to 64133% of the poverty line
- 1 person
- $1,769
- 2 people
- $2,400
- 3 people
- $3,029
- 4 people
- $3,658
- 5 people
- $4,288
- 6 people
- $4,918
- 7 people
- $5,547
- 8 people
- $6,177
- 9 people
- $6,806
- 10 people
- $7,435
Parents and caretakers58% of the poverty line
- 1 person
- $772
- 2 people
- $1,047
- 3 people
- $1,321
- 4 people
- $1,595
- 5 people
- $1,870
- 6 people
- $2,145
- 7 people
- $2,419
- 8 people
- $2,694
- 9 people
- $2,968
- 10 people
- $3,243
Pregnant194% of the poverty line
- 1 person
- $2,581
- 2 people
- $3,500
- 3 people
- $4,418
- 4 people
- $5,335
- 5 people
- $6,255
- 6 people
- $7,173
- 7 people
- $8,090
- 8 people
- $9,010
- 9 people
- $9,927
- 10 people
- $10,845
Source: Nebraska DHHS guidance document 'Medicaid Income Levels, Federal Poverty Levels, and Resources,' figures effective 1/1/2026 (issued under Neb. Rev. Stat. § 84-901.03). On the DHHS site it is the link labeled 'Federal Poverty Level and Program Eligibility' on the Medicaid Eligibility page. A note on precision: Nebraska's own sources disagree on whether the expansion limit is 133% or 138% of the poverty line, and on the matching annual dollar figures. We publish the state figure.
Two other changes land on the same day
Renewals get more frequent, and back-dated coverage gets shorter.
P.L. 119-21 §71112, amending 42 U.S.C. §1396a(a)(34). Applies to applications submitted on or after January 1, 2027.
Nebraska has no law that would end expansion automatically
It is not a guarantee.
Neb. Rev. Stat. § 68-992 contains no FMAP condition, no funding contingency, and no sunset clause.
Nebraska has no statute that would automatically end or roll back Medicaid expansion if the federal matching rate fell. KFF's tracker of state expansion actions, as of its August 2026 data, records Nebraska as 'Adopted' effective 10/1/2020, 'Expansion Adopted Through Ballot Initiative: Yes (November 2018)', and 'Trigger Law In Place: No.' A review of Nebraska Legislature bill lists for the 2019 through 2026 sessions found no bill that would have created one. Trigger and sunset mechanisms were debated in the pre-initiative legislative attempts — an amendment to LB577 in 2013 and a three-year sunset in LB1032 in 2016 — but neither passed, and Initiative 427 deliberately contained none.
Where the protection stops. The absence of a trigger law is not the same thing as strong protection, and Nebraska's protection is materially weaker than Missouri's or Oklahoma's. Those states amended their constitutions; their legislatures cannot touch expansion by ordinary bill at all. Nebraska's expansion is an ordinary statute. Its only shield is Nebraska Constitution Article III, Section 2, which provides that the Legislature 'shall not amend, repeal, modify, or impair a law enacted by the people by initiative ... at any time thereafter, except upon a vote of at least two-thirds of all the members of the Legislature.' That protection is permanent — there is no three-year window after which it lapses, and the 'once in three years' language elsewhere in Article III, Section 2 is a limit on petitioners resubmitting a measure, not a moratorium on the Legislature. The supermajority itself was added by Initiative Measure No. 418 in 2004; before that a simple majority was enough. In the 49-member unicameral Legislature, two-thirds is 33 votes — the same number as cloture, so a coalition able to break a filibuster is already able to amend an initiative, with no additional procedural hurdle. And a veto override takes only three-fifths, or 30 votes, so any 33-vote coalition automatically has a veto-proof margin. The decisive fact is that the current Legislature has cleared that 33-vote bar twice in a row on other voter-approved initiatives: LB415 in 2025 narrowed the 2024 paid-sick-leave initiative 33-16, and LB258 in 2026 gutted the inflation escalator in the 2022 minimum-wage initiative 33-16 on a party-line vote, signed by Gov. Pillen on February 10, 2026. Repealing or narrowing § 68-992 is therefore within reach of a single ordinary legislative session acting with a supermajority it has recently demonstrated it can assemble.
No one has tried to create a trigger. Every Nebraska bill found touching expansion between 2019 and 2026 ran the other way — toward protecting enrollees or constraining how the federal work requirement is implemented — and all of them died. LB815 (2020, Morfeld) would have barred DHHS from pursuing any section 1115 waiver for the expansion group; LB932 (2020, Wishart) would have codified the October 1, 2020 start date; LB723 (2026, Quick) would have adopted the H.R. 1 community engagement rules only as federally required and maximized exemptions; LB812 (2026, Bostar) would have limited redetermination frequency and constrained work-requirement verification; LB1221 (2026, Ballard) would have defined the H.R. 1 short-term hardship terms in state law and advanced to General File before being indefinitely postponed on April 17, 2026. LB929 (2026, Fredrickson), limiting cost-sharing on enrollees, actually passed 31-18 on April 10, 2026 and was then vetoed by the Governor. In the other direction, LR297CA (2026, M. Cavanaugh) would have amended the constitution to require that any two-thirds legislation altering an initiative be referred back to voters before taking effect; it was indefinitely postponed.
As it stands. No trigger law exists as of October 2026, and none has been proposed. But do not describe Nebraska's expansion as protected the way Missouri's and Oklahoma's are. The pressure on the program in 2026 came from the executive branch and from federal law, not from a repeal bill: Gov. Pillen chose to start the federal work requirement eight months early, and DHHS separately floated a 'Nebraska Sustainable Coverage Waiver' to eliminate retroactive eligibility before deciding not to submit it.
Do this now
Update your address and phone number first. Everything about the new rules arrives by mail, and a stale address is the most common reason people lose coverage they are still entitled to. Then check whether an exemption applies to you.
About the phone numbers: Lines are weekdays only, 8 to 5 Central — there is no evening or weekend live service, which matters because a work-requirement information request runs on a 30-day clock. DHHS allows 5 days of mail time before the 30 days start and prints the actual due date on the notice. Keep your address, phone number and email current with DHHS: stale contact information is a common reason coverage closes, and it is how people miss the work-requirement notice entirely.
Deaf, hard of hearing or speech-impaired: 402-471-7256 (Medicaid eligibility TTY/TDD); the DHHS statewide TDD line is 1-800-833-7352; managed care plans use 711 relay.
Nebraska DHHS publishes its Medicaid expansion and Heritage Health Adult beneficiary FAQ in nine languages — English, Spanish, Vietnamese, Chinese, Karen, Somali, Arabic, French and Burmese. The work requirements FAQ, the outreach notice, the declaration form and the explanatory videos are available in English and Spanish, as are the application and renewal forms and the fair hearing request. Beyond the printed materials, DHHS provides free language services on request, including oral interpretation, translated documents, qualified sign language interpreters, large print and audio formats. Interpretation during medical care is itself a covered Medicaid benefit in Nebraska: since July 1, 2024, Medicaid pays providers for sign language, oral interpretation and translation services, so you should not be charged for an interpreter at an appointment. Members in a Heritage Health plan can get information interpreted in any language at no cost by calling the Heritage Health Enrollment Center at 1-888-255-2605, TTY 711, and enrollment materials are available in braille and audio recording free of charge.
Most people who lose coverage lose it over paperwork, not eligibility
In state fiscal year 2025, Nebraska completed 349,242 renewal determinations: 249,049 people kept their eligibility and 100,193 were closed, a retention rate of about 71%. The state processed 177,663 applications, approving 94,738 and denying 82,925. Median processing time was 13 days for MAGI cases and 12 for non-MAGI.% of the coverage losses recorded in Nebraska were procedural — a form, a deadline, or an address, rather than a real change in whether someone qualified. From May 1, 2026 that matters more, not less.
NOTICE OF ELIGIBILITY DETERMINATION
Case number: ███████
Date of this notice: 1January 12, 2027
Our records do not show that you met the community engagement requirement for the reporting period.
2If you believe this is incorrect, or if an exemption applies to you, contact us on or before February 11, 2027.
3Coverage for other members of your household is not affected by this notice.
What the federal data says about coverage here
Public federal data describes how each state runs its program. Almost all of it is written for policy analysts. Here is what those numbers mean if you are the person enrolled.
Of people who lost coverage here, this share lost it over paperwork rather than eligibility.
Open every letter. Keep your address current with the agency.
Records here are relatively accurate, so treat a notice as real rather than assuming a mistake.
Provider supply here is around the national middle.
Book an appointment before you need one, not when you do.
Where you live in this state changes what coverage is worth. Nebraska is overwhelmingly rural once you leave Omaha and Lincoln: 88 of its 93 counties are rural or frontier, 30 of them frontier, and 37% of the state's 1.96 million people live in those areas. Rural hospitals make up about 68% of Nebraska's hospitals against 35% nationally, and nearly 60% of the state's 62 critical access hospitals ran deficits in 2024. In its own 2025 Rural Health Transformation Program application to CMS, DHHS reported that 66 Nebraska counties are primary care shortage areas, 61 are dental shortage areas, and 88 are psychiatry and mental health shortage areas; that 26% of counties have no behavioral health provider at all; that 71 counties contain an ambulance desert, meaning somewhere more than 25 minutes from the nearest ambulance station; that more than half of Nebraska counties are maternity care deserts, with only 44 birthing facilities statewide; and that 20% of physicians now practicing in Nebraska expect to retire within ten years. DHHS also told CMS plainly, in its 2025 Managed Care Program Annual Report, that 'it is difficult to find providers, especially specialists, in the rural and frontier areas,' and that the statewide pool of specialists available to recruit is small. Nebraska's own network adequacy standards are written around that reality: a primary care provider must be within 30 miles in urban areas but 45 miles in rural and 60 miles in frontier ones, and the standard for inpatient and residential behavioral health care in rural and frontier Nebraska is a 480-mile round trip. UNMC counted 21 of the 93 counties with no primary care physician at all in 2023, and found the state lost 57 primary care physicians between 2017 and 2023, with a further 9% decline projected by 2030. This is why the work requirement's county hardship list matters so much here: almost every one of the fourteen counties currently excused is rural, and someone in a county with no ambulance within 25 minutes may also be in a county where getting a paystub, a school transcript or a treatment provider's details to a DHHS office inside 30 days is genuinely hard. Nebraska DHHS, Rural Health Transformation Program Project Narrative (2025), pp. 6-7 and 13-14, citing HRSA HPSA Find and UNMC/BHECN (https://dhhs.ne.gov/documents/ne%20final%20project%20narrative%20rhtp%202025.pdf); Nebraska DHHS, 2025 Nebraska Managed Care Program Annual Report, Section C Topic V (https://dhhs.ne.gov/Documents/2025%20Nebraska%20Managed%20Care%20Program%20Annual%20Report%20(MCPAR).pdf); University of Nebraska Medical Center, 2023 Status of the Nebraska Healthcare Workforce (2024).
Questions people ask about this
Do the new Medicaid work rules apply to me in Nebraska?
How many hours a month do I have to work?
Who is exempt from the work requirement in Nebraska?
When do the Nebraska work rules start?
What is the income limit for Nebraska Medicaid?
How do I apply for Nebraska Medicaid covers adults 19-64 through Heritage Health Adult, the voter-approved expansion group, at up to 133% of the federal poverty line under the state's own income table (138% once the standard 5% income disregard is applied). Parents and caretaker relatives who are not in the expansion group have a far lower separate limit of 58% FPL. There are also aged, blind, and disabled pathways.?
How often do I have to renew Nebraska Medicaid?
Guides for neighboring states
The rules change completely at the state line. If you moved recently, or you're helping family somewhere else, start with their state rather than this one.
Nebraska has been enforcing Medicaid work requirements since May 1, 2026 — the first state in the country, eight months before the federal deadline — and the state's own first results show the real danger is mail, not work.
Of the Nebraskans who lost or were denied coverage over the requirement between May and August 2026, 84% of applicants and 92% of renewers were cut for failing to return the information DHHS asked for, not for failing to work enough. So the thing to do today is make sure DHHS has your current address, phone number and email, and open everything it sends: most people never get a request at all, because DHHS checks its own data first, but if a Verification of Compliance notice and declaration form do arrive you have 30 days from the date printed on it, and you can respond online at iserve.nebraska.gov, by phone at 1-855-632-7633, by mail, or at a local office. If your coverage already closed because you did not send information in, call that number — you keep a 90-day reconsideration period and the case can be reopened without a new application, whereas someone denied for genuinely not meeting the requirement has to reapply from scratch. And check whether you are simply exempt: parents and caretakers of a child 13 or younger, people caring for someone with a disability, tribal members and Indian Health Service patients, pregnant and postpartum people, the medically frail, veterans with a total disability rating, and residents of the fourteen mostly rural counties currently excused for high unemployment or a disaster declaration all qualify, and exemptions accounted for more coverage approvals than working did.
Updating your address takes two minutes and protects everything else. Do that first, then check the exemption list above.
Go to Apply online at the iServe Nebraska portal →