Gizmo Warehouseby Joe Eichenbaum | 17A

Medicaid work requirements · Nebraska

Medicaid work requirements in Nebraska: who is subject and who loses coverage (2027)

Data snapshot 2026-06-03 · part of These 5 Million People Are About to Lose Their Medicaid — But They Don't Have To

Nebraska expanded Medicaid, so the federal work requirement that takes effect January 1, 2027 applies to its expansion adults. About 65,180 of them (5.7% of an expansion pool of 69,678) will have to prove 80 hours a month of work, school, or service, or an exemption, to keep coverage.

This model's bottom-up estimate is that 27,359 people in Nebraska lose coverage by 2034: 25,403 of them still eligible but lost to paperwork and reporting failures, and 1,955 not meeting the requirement. Nationally the same model gives 5,461,400, against CBO's 5,200,000.

Whether those eligible people keep coverage depends on the state's ability to renew them automatically (ex parte) from data it already holds. Nebraska scores 62 of 100 on this model's ex parte capability index, a mid band; its eligibility system is N-FOCUS.

Key figures

Model v2-2026-06-03. "Strict" counts adults whose ACS record shows them subject with no observable exemption; "permissive" allows the broader exemption reading.
MeasureNebraska
Expansion stateYes
Subject to the requirement via waiverNo
Expansion pool (adults 19 to 64)69,678
Adults subject, strict definition65,180
Adults subject, permissive definition63,876
Share of expansion pool subject5.7%
Projected coverage loss by 203427,359
Hardship exception statusAdopting
Early implementer2026-05-01 (live)
Ex parte capability score (0 to 100)62 (mid)

Who is subject in Nebraska

Of the 65,179 subject adults, 42% already work 80 or more hours a month and 49% are not working. 34% have a child under 14 at home. Among those not working, 60% report a disability and 13% are caregivers.

ACS PUMS 5-year 2020 to 2024, subject adults only.
CharacteristicShare of subject adults
Age 19-2415%
Age 25-3421%
Age 35-4420%
Age 45-5418%
Age 55-6426%
Not working49%
1 to 19 hours a month2%
20 to 79 hours a month7%
80 or more hours a month (meets the bar)42%
Not working: Disabled60%
Not working: Caregiver13%
Not working: Postpartum0%
Not working: Student2%
Not working: Other25%

Why eligible people lose coverage

Of the 27,359 projected to lose coverage in Nebraska, 25,403 meet the requirement or qualify for an exemption but fail to document it. 11,033 of those are working people who cannot prove their hours through data the state can see, and 14,370 qualify for an exemption the state does not detect automatically.

Bottom-up model v8.0-2026-05-30; documentation-failure buckets compound over the 14 six-month renewal cycles through 2034.
GroupProjected to lose coverage
Variable shifts / on-call work2,552
Self-employed (other)2,527
Multiple part-time jobs (aggregation failure)2,525
Cash-paid construction & trades944
Full-time students not auto-verified897
Volunteering / job training721
Seasonal: agriculture, hospitality, food service678
Gig / courier (DoorDash, Uber, Lyft, Instacart)188
Medically frail without auto-match4,606
Parent caregivers of children ≤13 without auto-match3,199
Caregivers of a disabled adult2,698
American Indian / Alaska Native (tribal exemption)1,572
Kinship caregivers (non-parent) of children ≤13746
Recent incarceration (data-match gap)689
SUD treatment not flagged in claims data480
Other categorical exemptions (foster, AYA cancer, SNAP/TANF)337
Pregnancy / postpartum data lag44

Can the state renew people automatically?

The ex parte capability index blends the state's observed automatic-renewal rate (63% in CMS eligibility-processing data), the wage, disability, and other data sources it can query, and its history of churn. Nebraska's composite score is 62 (mid band). A low score means more eligible people will be dropped for paperwork unless the state changes its process before January 1, 2027.

ComponentScore
Composite62
Observed ex parte63
Core capability32
Data sources65
Historical churn50

How subjects overlap across exemption categories

Each subject adult sits in exactly one cell. Categories: Working ≥ qualifying hours / income; Parent caregiver of child ≤13; Medically frail; Full-time student.
CombinationAdultsShare
None of the four19,61130.1%
Working ≥ qualifying hours / income11,52517.7%
Medically frail11,17717.2%
Working ≥ qualifying hours / income + Parent caregiver of child ≤1310,58116.2%
Parent caregiver of child ≤133,7305.7%
Working ≥ qualifying hours / income + Full-time student2,8354.3%
Full-time student2,1833.4%
Working ≥ qualifying hours / income + Medically frail1,1091.7%

Counties in Nebraska

Subject adults concentrate: Douglas County (17,709), Lancaster County (11,571), and Sarpy County (5,798) account for 54% of the state's subject population.

All 93 counties in Nebraska with subject adults, sorted by count. County figures are model allocations of the state estimate by ACS tract characteristics.
CountyAdults subjectSubject rateProjected lossPoverty rateWorking-age population
Douglas County17,7095.1%7,43311.0%350,210
Lancaster County11,5715.9%4,85712.0%197,488
Sarpy County5,7984.9%2,4345.0%117,702
Hall County2,0145.8%84613.0%34,820
Buffalo County1,7856.0%74912.0%29,639
Dodge County1,2476.1%5239.0%20,379
Platte County1,2226.5%5138.0%18,676
Scotts Bluff County1,1806.1%49512.0%19,270
Lincoln County1,1516.2%48311.0%18,480
Madison County1,1405.7%47812.0%19,872
Adams County1,0716.2%44912.0%17,198
Cass County9205.9%3866.0%15,528
Saunders County8116.3%3417.0%12,832
Dawson County8106.1%34014.0%13,244
Gage County7606.5%31913.0%11,758
Washington County7426.3%3128.0%11,774
Dakota County7015.8%29411.0%12,088
Seward County6786.9%2847.0%9,782
Otoe County5626.4%23611.0%8,806
York County5186.6%2179.0%7,896
Saline County5086.2%21311.0%8,258
Wayne County4207.3%17617.0%5,730
Box Butte County3756.6%15712.0%5,718
Custer County3716.8%15611.0%5,482
Colfax County3716.4%15610.0%5,791
Holt County3677.2%15410.0%5,116
Red Willow County3666.3%15412.0%5,855
Hamilton County3276.4%1376.0%5,108
Cheyenne County3266.2%13712.0%5,302
Knox County3127.6%13112.0%4,089
Cedar County3117.3%1315.0%4,240
Cuming County3096.6%1308.0%4,711
Phelps County3086.4%12914.0%4,809
Keith County3027.2%12712.0%4,212
Dawes County2926.1%12313.0%4,760
Butler County2886.3%1218.0%4,563
Richardson County2836.9%11911.0%4,112
Nemaha County2666.8%11215.0%3,900
Merrick County2626.2%11010.0%4,226
Pierce County2606.6%1098.0%3,934
Jefferson County2576.9%10811.0%3,714
Burt County2396.8%10014.0%3,526
Antelope County2377.7%10011.0%3,088
Kearney County2306.3%979.0%3,650
Howard County2216.6%935.0%3,347
Clay County2196.7%929.0%3,294
Thurston County2166.3%9119.0%3,410
Stanton County2106.8%887.0%3,102
Dixon County2057.2%869.0%2,857
Polk County2027.2%858.0%2,794
Cherry County1976.8%8310.0%2,916
Boone County1937.1%817.0%2,736
Fillmore County1916.1%807.0%3,103
Sheridan County1817.2%7611.0%2,513
Thayer County1797.1%7510.0%2,507
Furnas County1667.0%7011.0%2,368
Johnson County1564.9%656.0%3,192
Morrill County1536.3%6410.0%2,420
Nuckolls County1457.0%616.0%2,090
Valley County1406.7%599.0%2,082
Chase County1246.7%528.0%1,845
Kimball County1237.4%5210.0%1,662
Nance County1216.8%5114.0%1,796
Webster County1206.6%508.0%1,829
Sherman County1198.1%5011.0%1,474
Franklin County1117.6%4715.0%1,450
Brown County1077.4%459.0%1,452
Harlan County1057.6%447.0%1,372
Frontier County1038.1%4312.0%1,280
Hitchcock County987.8%4112.0%1,262
Perkins County956.6%409.0%1,430
Pawnee County958.3%4013.0%1,144
Gosper County837.5%357.0%1,113
Greeley County837.6%3512.0%1,096
Deuel County707.1%297.0%982
Boyd County698.6%2912.0%804
Garfield County667.8%2812.0%850
Garden County667.7%2810.0%859
Dundy County636.6%2612.0%947
Rock County538.0%229.0%660
Sioux County406.9%1717.0%580
Banner County369.7%157.0%378
Wheeler County327.4%1310.0%432
Keya Paha County317.8%139.0%396
Hayes County306.7%1215.0%444
Grant County278.0%1111.0%338
Logan County267.1%119.0%372
Loup County258.3%118.0%302
Thomas County258.9%117.0%281
McPherson County239.0%108.0%259
Hooker County225.8%98.0%382
Blaine County189.3%811.0%194
Arthur County177.4%77.0%232

State brief and methodology

Estimates, not counts. The model rakes to CBO's national subject total and allocates by ACS microdata; state agencies hold the administrative data that would replace these figures.

Sources

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