Policy & oversight
Nebraska Data Shows 7 Percent of Medicaid Enrollees Lost Coverage Under New Work Rules, Raising Concerns for Medicare Dual-Eligibles
Three states moved ahead of a national January 2027 deadline to add work and reporting requirements to Medicaid. Early figures from Nebraska show most coverage losses stemmed from paperwork problems, not actual ineligibility.
By the Goodsurance editorial teamOctober 12, 2026
Three states, Nebraska, Montana, and Arkansas, chose to implement Medicaid work and activity-reporting requirements before a national January 1, 2027 deadline. On October 8, Medicare Rights Center summarized early data from Nebraska and Montana, drawing on KFF analysis.
Nebraska launched its program on May 1. Of the people enrolled in Medicaid expansion who faced the new requirements, the majority qualified for an exemption: 57 percent were medically frail, caregivers, or otherwise exempt, and 46 percent were already working or enrolled in qualifying activities. Even so, 7 percent of current enrollees lost coverage, and 14 percent of new applicants were denied. Medicare Rights Center noted that most of the denials were linked to missing documents or incomplete information, suggesting that a substantial share of people who lost coverage may have actually qualified.
Early data from Nebraska shows most Medicaid coverage losses were caused by missing paperwork, not ineligibility, as a national January 2027 work-requirement deadline approaches.
Montana began implementation in July with an October 1 compliance deadline. Medicare Rights Center reported widespread confusion among enrolled residents and limited outreach from the state.
For people enrolled in both Medicare and Medicaid, known as dual-eligible beneficiaries, losing Medicaid means losing assistance with Medicare Part A and Part B premiums, deductibles, and cost-sharing. Starting January 1, 2027, all states with expanded Medicaid are required to enforce these requirements. The administrative difficulties observed in Nebraska and Montana have raised concern that a national rollout could leave a broader share of dual-eligible Medicare beneficiaries without supplemental Medicaid coverage.
In plain words
Some people have both Medicare and Medicaid. Medicaid helps pay their Medicare costs. Three states started adding new rules before the rest of the country. These rules say people must work or report activities to keep Medicaid. Nebraska started in May. Early numbers show that 7 out of 100 current members lost their Medicaid. And 14 out of 100 new applicants were turned away. Most of the people who lost coverage were denied because of missing paperwork, not because they did not qualify. Montana started its program in July but many people were confused. Starting January 1, 2027, all states must add these rules. People who lose Medicaid may also lose help paying for Medicare. That could mean higher costs for people who have both programs.
Understand the basics first
Source: Medicare Rights Center
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