Nebraska became the first state in the nation on Friday to enforce new work requirements for Medicaid applicants as part of a sweeping tax and policy law President Donald Trump signed last year.
The new work requirements are the result of HR1, also known as Trump's One Big Beautiful Bill.
Certain adults on Medicaid must work or do similar activities to keep Medicaid coverage, according to Trump's law. It mainly applies to low-income adults ages 19 to 64 who qualify through the Affordable Care Act Medicaid expansion.
It also applies to "able-bodied" adults without dependent children.
Those Medicaid participants will have to work or do community service at least 80 hours a month, or enroll at least half-time as a student.
“Welfare should be a hand up, not a hand out, and this will encourage able-bodied adults to join the workforce — and ultimately help these folks know that their contributions to our state make a difference," the governor added. "We have extraordinary careers just waiting for extraordinary people."
Advocates expressed concerns over implementation of the new work requirement, since each state has its own system for managing Medicaid. States have been forced to update online portals used by Medicaid participants, aging computer systems used by state workers, and methods of verifying information through various databases.
Nebraska officials, however, said they prepared for such changes by training staff and sending letters, emails, and texts to those who could be impacted.
The state's move to be the first state to roll out the change is likely to be watched closely by health policy experts and other states.
“It can be used as a lesson for other states, both where things go well and where things don’t go well,” according to Jennifer Tolbert, deputy director of KFF’s Program on Medicaid and the Uninsured.
Trump's big tax-cut law is financed, in part, by sweeping Medicaid changes intended to cut government spending.
According to the Congressional Budget Office, the new provisions are projected to save the federal government $388 billion over the next decade, resulting in 6 million fewer people with health insurance.