Impacts of the OBBBA's Medicaid Work Requirements in Nebraska
Experiences of First State to Implement Work Requirements Foreshadows Risks as Nationwide Deadline Draws Near
On July 4, 2025, President Trump signed the One Big Beautiful Bill Act (OBBBA) into law. In addition to containing tax cuts that overwhelmingly benefit high-income households and corporations, the OBBBA cut spending on Medicaid by mandating that states subject enrollees and applicants to work requirements. Under these new rules, most adults without dependents will need to document at least 80 hours per month of work, education, or related activities by the end of 2026 to maintain Medicaid coverage. The Congressional Budget Office estimates that the OBBBA's work requirements will increase the number of uninsured individuals in the U.S. by 4.8 million by 2034.
In May 2026 — eight months before the federal deadline — Nebraska became the first state in the country to implement the OBBBA’s Medicaid work requirements. Human Rights Watch and Oxfam America interviewed over a dozen Nebraskans with personal or professional experience with Medicaid in August and September. We found that Nebraska’s effort to implement the OBBBA’s work requirements underscore fears that millions of people will experience avoidable barriers to healthcare coverage.