Nebraska Medicaid Work Rules Catch 64-Year-Old Cancer Patient Off Guard

Eli McCreary, a 64-year-old resident of Omaha, Neb., received a phone call from a CHI Health hospital informing him that his Medicaid coverage had been dropped. The hospital told him his appointments would be cancelled unless he paid for services out-of-pocket. McCreary had recently been diagnosed with kidney cancer, diabetes, and chronic obstructive pulmonary disease. He called a help center and was told he lost his benefits because he had not met a new work requirement.

The first key point is the immediate impact on patient care. McCreary cancelled a CT scan and other tests at the hospital. He also delayed a cancer-related appointment with a specialist who travels to Omaha. McCreary said he missed his window of opportunity for that appointment by one month. He described his physical limitations, stating he could not walk, hardly breathe, and could not move around easily.

The second key point concerns the rollout of the new rules. Nebraska launched the Medicaid work requirements on May 1, making it the first state to enforce the provisions of the One Big Beautiful Bill Act. This was eight months before most other states are set to implement similar rules. Approximately 70,000 adult Medicaid recipients in Nebraska are subject to these requirements. They must prove they are working or participating in similar activity for 80 hours a month unless they qualify for an exemption.

The third key point involves the state's administrative spending and staffing. State documents show Nebraska budgeted $8.2 million in contractor costs over two years to enact these changes. The funds were spent on two companies, Public Consulting Group and Covendis, to increase agency staffing and manage information technology. Nebraska Department of Health and Human Services spokesperson Jeff Powell said the state uses contracted staff when hiring state employees is uneconomical or impractical.

Context for the situation includes political and legal debates surrounding the program. Nebraska Gov. Jim Pillen praised the changes in December, saying the administration delivered key reform. He spoke alongside a videoed-in appearance by Mehmet Oz, the federal official overseeing Medicare and Medicaid. Democrats in Congress have said they plan to repeal the Medicaid changes in their first 100 hours in office in January, though a presidential veto is a possibility. State data indicates that 86% of affected applicants met the requirement or qualified for an exclusion, while 93% of existing enrollees kept their coverage.

Advocates and health centers report confusion among enrollees. Sarah Maresh, program director at Nebraska Appleseed, described the contractor costs as shocking. Kenny McMorris, CEO of the Charles Drew Health Center in North Omaha, noted that roughly half of the center's 13,385 patients are on Medicaid. Of those, 42% are subject to the work requirements. McMorris said working patients often lack time to navigate the phone systems required to verify their status.

Call center wait times increased significantly during the rollout. Average wait times at the Nebraska health department call center nearly doubled from about 13 minutes in May to 26 minutes in July. The center received more than 101,000 calls in August, a 66% increase from May. McCreary said he called a number he believed was the state Medicaid line but was actually connected to a private call center for food assistance accounts. The state has no record of him calling the health department directly.

Attorneys and policy professionals said McCreary’s four-month substance use treatment and other health conditions should have exempted him from the work rules. The federal law includes exemptions for people who are too sick to work, including those with serious medical conditions or substance use disorders. McCreary, who previously worked as a driver for an asphalt services company, said he worked until his health declined. He said he was in despair when the hospital called but eventually sought help.

McCreary does not have an account on the Nebraska Medicaid online portal and prefers to handle matters by phone or in person. He acknowledged it is possible he missed letters about his coverage. The Congressional Budget Office estimated the policy changes will lead to 5.3 million more people being uninsured in the U.S. by 2034. Next year, work requirements will apply to millions of adult Medicaid enrollees in more than 40 states.