Nebraska Medicaid Work Rules Force Cancer Patient to Cancel Care

Eli McCreary, a 64-year-old resident of Omaha, Neb., was diagnosed with kidney cancer in June after being discharged from a substance use treatment program in March. Shortly after the diagnosis, McCreary received a call from a local hospital operated by CHI Health. The hospital informed him that his Medicaid insurance had been terminated and that his scheduled appointments would be canceled unless he paid for the services out of pocket.

McCreary contacted a call center for assistance and was told that his benefits now required him to maintain employment. A representative stated, "You're required to do work to stay on," and added that he had not fulfilled the work requirement. McCreary, who also suffers from diabetes and chronic obstructive pulmonary disease, said he could not walk or breathe easily enough to work. He subsequently canceled a CT scan and other tests. He also delayed a cancer-related appointment with a traveling physician, noting that he missed his window of opportunity for another month.

Nebraska became the first state to enforce Medicaid work requirements under the One Big Beautiful Bill Act on May 1. The state mandates that adult recipients work or participate in similar activities for 80 hours per month unless they qualify for an exemption. State officials reported that 86% of affected applicants met the requirement or qualified for an exclusion. Jeff Powell, a spokesperson for the Nebraska Department of Health and Human Services, said the rollout has been very successful. However, advocates argue the process has been plagued by poor training and inadequate staffing.

Internal documents reviewed by KFF Health News show that most denials among adults applying for Medicaid in early July were due to unsubmitted paperwork. The state labeled this outcome as expected. Average wait times at the state health department call center nearly doubled between May and July, rising from about 13 minutes to 26 minutes. Nebraska received more than 101,000 calls in August, a 66% increase from May. Kenny McMorris, CEO of the Charles Drew Health Center, noted that roughly half of his facility's 13,385 patients are on Medicaid, and 42% of those patients are subject to the new work requirements.

The state spent $8.2 million over two years on contractors to implement the changes. Public Consulting Group and Covendis were hired to increase agency staffing and supply information technology personnel. Sarah Maresh, a program director with Nebraska Appleseed, described the costs as shocking. She stated that large corporations were making money behind the scenes while the state implemented complex policies quietly. Nebraska submitted these records to federal regulators as part of a routine process to secure federal funding. Powell said the funding requests might not reflect actual expenditures.

Attorneys and policy professionals reviewed McCreary's case and said his four-month substance use treatment and other health conditions should have exempted him from the work rules. The federal law includes categories for those who are too sick to work, such as individuals with a serious medical condition or substance use disorder. McCreary said he did not know the rules applied to him. He previously worked as a driver for an asphalt services company until his health deteriorated. He recalled dialing a number that connected him to a private call center for food assistance accounts rather than the state Medicaid line. The state health department has no record of McCreary calling its AccessNebraska call center. McCreary said he is unsure if he missed letters regarding his coverage. He added, "This cancer ain't going to stop just because I ain't got insurance."

The Congressional Budget Office estimates the policy will leave 5.3 million more people uninsured in the United States by 2034. Work requirements are set to apply to millions of adult Medicaid enrollees in more than 40 states next year. Taylor Miller, a spokesperson for CHI Health, said the system is committed to helping patients understand their coverage and access to financial assistance. She did not answer specific questions about McCreary's experience. Laura Strimple, a spokesperson for Gov. Jim Pillen, did not respond to requests for comment.