Nebraska Medicaid Work Rules Hit Cancer Patient

Eli McCreary, a 64-year-old resident of Omaha, received a call from a local CHI Health hospital in June informing him that his Medicaid coverage had lapsed. He was diagnosed with kidney cancer in the right kidney around the same time. The hospital told McCreary that his appointments would be canceled unless he paid out of pocket. He had just finished a substance use treatment program in March and also manages diabetes and chronic obstructive pulmonary disease.

Nebraska began enforcing Medicaid work requirements on May 1, making it the first state to implement the rules under the One Big Beautiful Bill Act. Most other states are scheduled to follow in eight months. Adults subject to the rules must prove they work or participate in similar activities for 80 hours per month. About 70,000 adult Medicaid recipients in Nebraska are affected. State officials said 86% of affected applicants met the requirement or qualified for an exclusion, and 93% of existing enrollees kept their coverage.

McCreary called a help line and was told he had not fulfilled his work requirement. A representative told him, 'You're required to do work to stay on. And you haven't fulfilled your work requirement.' McCreary said he did not understand what job he could get given his condition. 'I can't walk. I can hardly breathe. I can't move around. What job am I going to get?' he asked. He canceled a CT scan and delayed a cancer appointment with a specialist who travels to Omaha.

Nebraska spent $8.2 million over two years on contractors to implement the changes. The costs included staffing from Public Consulting Group and Covendis. One contractor received more than $1.8 million. Sarah Maresh, program director at Nebraska Appleseed, called the amounts shocking. She said large corporations were making money behind the scenes. Kenny McMorris, CEO of the Charles Drew Health Center in North Omaha, said half of his patients are on Medicaid, and 42% of those are subject to the work requirements.

Average wait times at the Nebraska health department call center doubled between May and July, rising from 13 minutes to 26 minutes. The state received more than 101,000 calls in August, a 66% jump from May. McMorris noted that working patients often do not have time to sit on the phone. 'You can leverage the technology, but you still got to have people there to help,' he said. Taylor Miller, a spokesperson for CHI Health, said the system is committed to helping patients understand their coverage and access to financial assistance.

McCreary said he was in despair when he learned his coverage was gone. He eventually called for help but reached a private call center for SNAP accounts instead of the state Medicaid line. State officials said they have no record of him calling the health department. Attorneys said his recent substance use treatment and other health conditions should have exempted him from the work requirement. The federal law allows exemptions for people with serious medical conditions or substance use disorders.

Gov. Jim Pillen called the reform a key achievement and said the rollout has been very successful. He spoke alongside video footage of Mehmet Oz, the Trump administration official overseeing Medicare and Medicaid. Democrats in Congress have said they plan to repeal the changes in their first 100 hours in office in January, though a Trump veto is possible. The Congressional Budget Office estimates the policy will leave 5.3 million more people uninsured by 2034.