OMAHA, Neb. (AP) — Nebraska on Friday will become the first state to enforce work, volunteer or education requirements for new Medicaid applicants, eight months before the federally mandated requirements kick in.
Advocates worry that the state is launching so rapidly that key details remain unresolved and some people who are eligible for coverage will lose it.
State officials say they're prepared, training staff and sending letters, emails and texts to people who could be impacted.
Health policy experts, advocates and other states will be watching closely.
“It can be used as a lesson for other states, both where things go well and where things don’t go well,” said Jennifer Tolbert, deputy director of KFF's Program on Medicaid and the Uninsured.
The work requirement is part of a broad tax and policy law that President Donald Trump signed last year. Nebraska Republican Gov. Nebraska Gov. Jim Pillen announced in December that the state would implement it eight months before it was required, saying the aim was “making sure we get every able-bodied Nebraskan to be a part of our community.”
The state had one of the lowest unemployment rates in the U.S. in February: 3.1%
The federal policy won't apply to all Medicaid beneficiaries, just those who are enrolled under an expansion that most states chose to make to allow more low-income people to get healthcare coverage.
Under the change, many Medicaid participants ages 19 through 64 will have to show that they work or do community service at least 80 hours a month, or are enrolled in school at least half-time. They'll also have their eligibility reviewed every six months rather than annually, so they could lose coverage faster if their circumstances change.
Exceptions will be made for people who are too medically frail to work or in addiction treatment programs, among others.
An Urban Institute report from March estimated that the changes would mean about 5 million to 10 million people fewer people nationally would be enrolled in Medicaid than would have been otherwise.
Choices states make about how to run their programs are expected to be a major factor in exactly how many people lose coverage.
“The higher the administrative burden, the more likely people are found noncompliant and disenrolled,” said Michael Karpman, who researches health policy at Urban.
Not everyone who has coverage will need to submit proof that they're working.
The state says it will first match enrollees with other data it has to see if participants are working or exempt. The state says it has that information for most of the roughly 70,000 people enrolled in Medicaid through the expansion.
That leaves between 20,000 and 28,000 who would have to provide more information, plus an average of 3,000 to 4,000 new enrollees each month.
At first, they will just need to show that they met the requirements in just one month of the previous 12. The time frame will shift to six months in 2027.
There's some flexibility. For instance, instead of showing they work 80 hours in a month, someone could instead provide records that demonstrate they earned at least $580, the amount someone earning minimum wage would make in 80 hours.
People who don't submit requested information within 30 days of being asked could have their applications denied or lose coverage they already have.
Bridgette Annable, who lives in southwest Nebraska, received a letter saying she must meet the work requirements or lose the benefits that pay for her insulin and diabetic supplies.
The 21-year-old mother now has a part-time job, despite being advised against it to protect her mental health. She’s worried about her ability to keep working.
“I am working 30 to 25 hours a week — as much as my employer can provide,” Annable said. “Although I call out of work often due to fibromyalgia pain and bipolar episodes that leave me too tired to leave the house. I have enough energy to take care of my daughter and do some cleaning, but that’s about it.”
Amy Behnke, the CEO of the Health Center Association of Nebraska, said that staff members who help people enroll with Medicaid and their clients have a lot of questions, including some that the state hasn’t yet answered.
Some examples: Apprenticeship programs are supposed to count for work requirements, but does that apply only to those certified by the state’s labor department? There’s an exemption for people who travel to a hospital for care, but there's not clarity on how far the journey must be.
KFF’s Tolbert noted that the state issued its 295-page list last week of conditions that could qualify someone as medically frail. “We don’t know if it’s a comprehensive list,” she said.
“The speed at which we are choosing to implement work requirements hasn’t left a lot of space for really meaningful communication,” Behnke said.
And Nebraska could have to make changes after the federal government provides guidance that is expected in June.
Mulvihill reported from Haddonfield, New Jersey.
FILE - Nebraska Gov. Jim Pillen, speaks during a news conference at the Department of Agriculture to rollout the USDA'S National Farm Security Action Plan in Washington, July 8, 2025. (AP Photo/Manuel Balce Ceneta, File)
Donald and Melania Trump both called for ABC to fire Jimmy Kimmel on Monday after a joke last week in which the late-night comic described the first lady as having “the glow of an expectant widow.”
The remark about the president's wife was part of a routine on Thursday's “Jimmy Kimmel Live” where the host pretended to deliver a comedy routine at the White House Correspondents' Association dinner. That event two nights later was cut short when a man armed with guns and knives tried to enter the Washington ballroom where the Trumps and much of the nation's political leadership had gathered.
“People like Kimmel shouldn’t have the opportunity to enter our homes each evening to spread hate,” Melania Trump said in a social media post later echoed by her husband.
Kimmel described the joke during his Monday night monologue as a light roast about the first couple's age difference and “not, by any stretch of the definition, a call to assassination."
He said he was sorry that the president and everyone at the event went through that traumatic and scary experience.
“I agree that hateful and violent rhetoric is something we should reject," Kimmel said. "I do, and I think a great place to start to dial that back would be to have a conversation with your husband about it.”
There was no comment Monday from ABC.
Kimmel has long targeted the president in his comedy, and he doubled down after a run-in with the administration last fall. Kimmel was suspended by ABC and some of the network's affiliates said they would take him off the air following a comment made about assassinated conservative leader Charlie Kirk, moves encouraged by Trump's FCC chairman, Brendan Carr. ABC and the stations later brought Kimmel back.
Upon his return, Kimmel said that by saying that “many in MAGA land are working very hard to capitalize on the murder of Charlie Kirk,” he was not trying to make light of Kirk's killing and didn't want to leave that impression. He did not apologize, however, and he criticized station owners who took him off the air before later relenting.
Shortly after the incident, ABC signed Kimmel to a one-year contract extension that is due to keep him on the air until May 2027. His show has aired on the network since January 2003.
His late-night competitor Stephen Colbert — another frequent Trump critic — is seeing his CBS show end next month.
Dressed in a tux and standing behind a podium Thursday, Kimmel pretended to deliver a comic routine for the WHCA dinner. His speech had false “cutaways” to the Trumps and others, taken from video clips.
He noted Melania in the “audience,” saying, “Mrs. Trump, you have a glow like an expectant widow.”
“I appreciate that so many people are incensed by Kimmel’s despicable call to violence, and normally would not be responsive to anything that he said but, this is something far beyond the pale,” the president said on his Truth Social platform. “Jimmy Kimmel should be immediately fired” by ABC and its parent Walt Disney Co., he said.
His wife said Kimmel's “hateful and violent rhetoric” is intended to divide the country. “A coward, Kimmel hides behind ABC because he knows the network will keep running cover to protect him," Melania Trump wrote. “Enough is enough. It is time for ABC to take a stand.”
White House press secretary Karoline Leavitt said it was part of a campaign of rhetoric from Democrats and some in the media that “has helped to legitimize this violence.”
“Who in their right mind says a wife would be glowing over the potential murder of her beloved husband?” Leavitt said. There was no indication that Kimmel was referring to violence.
The National Religious Broadcasters association filed a complaint with the Federal Elections Commission, asking the agency to investigate ABC.
“We're seeing a pattern of violence in this country that didn't appear overnight,” said Troy Miller, NRB's president and CEO. “When influential voices joke about death or treat political opponents as disposable, it contributes to a culture where violence feels thinkable to the already unstable.”
During his routine, Kimmel noted Melania Trump's birthday Sunday, saying, “She's planning to celebrate at home the same way she always does — looking out a window and whispering, ‘What have I done?’”
He also said: “Before we go any further, Melania, this is Donald. Donald, this is Melania. That was my impression of Jeffrey Epstein.”
Cole Tomas Allen, the California man arrested after attempting to rush into the correspondents' dinner on Saturday, was charged Monday with the attempted assassination of the president.
Associated Press correspondent Jesse Bedayn in Austin, Texas, and Hallie Golden in Seattle contributed to this report. David Bauder writes about the intersection of media and entertainment for the AP. Follow him at http://x.com/dbauder and https://bsky.app/profile/dbauder.bsky.social.
President Donald Trump gestures as he speaks in the James Brady Press Briefing Room at the White House after a shooting incident outside the ballroom at at the annual White House Correspondents' Association dinner in Washington, Saturday, April 25, 2026. (AP Photo/Jose Luis Magana)
FILE - First lady Melania Trump speaks to reporters April 9, 2026, in the Grand Foyer of the White House in Washington. (AP Photo/Jacquelyn Martin, File)
FILE - In this June 16, 2017, file photo, Jimmy Kimmel attends the 30th annual Scleroderma Foundation Benefit at the Beverly Wilshire hotel in Beverly Hills, Calif. (Photo by Chris Pizzello/Invision/AP, File)
