The Library Media — National & World · National Desk
By Catalina Clarke
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Nebraska rushed Medicaid work rules. Then a cancer patient was told he’d lost coverage
Nebraska moved first. On May 1, it became the first state in the country to enforce Medicaid work requirements under the One Big Beautiful Bill Act — eight months before most states — requiring about 70,000 adult recipients to prove 80 hours a month of work or similar activity, unless they qualify for an exemption.
Six months on, the state can point to numbers it calls a success. And one Omaha man’s case shows the friction underneath them — a case the state disputes.
Eli McCreary of Omaha was 64 when, in June, he was diagnosed with cancer in his right kidney. McCreary said a CHI Health hospital told him he had lost Medicaid, and that a call-center representative told him he had not fulfilled the work requirement.
The state tells it differently, and the difference is not a detail. Jeff Powell, a spokesperson for the Nebraska Department of Health and Human Services, maintained that McCreary had no lapse in coverage, and that he was disenrolled after turning 65 — aging into Medicare — before the work requirements applied to him. The state has no record of the call McCreary describes, Powell said, and the number McCreary recalls was an outsourced SNAP call center, not the state’s AccessNebraska line.
What is not disputed is where McCreary is now: on Medicare, recovering from surgery in early November to remove his right kidney. He said the cancer had grown.
Powell called the rollout “very successful,” citing state data that 86% of affected applicants met the requirement or qualified for an exclusion, and that 93% of existing enrollees kept their coverage.
The state’s own figures also record the costs of the speed. As of August, roughly 1,100 Nebraskans had been denied benefits over the work requirements — most of them not for failing to work, but for not responding to requests for information. Total Medicaid enrollment fell by roughly 4,600 people, about 1.4%, between May and August. And the call centers where recipients resolve exactly the kind of confusion McCreary describes slowed sharply: average waits nearly doubled, from about 13 minutes in May to about 26 minutes in July.
The rollout was not cheap to run. State documents obtained by KFF Health News through a public-records request show $8.2 million in contractor costs over two years to administer the requirements in a single state.
Nebraska is the early test of a national change. The Congressional Budget Office has estimated that the law cuts federal Medicaid spending by more than $900 billion over a decade, and that 5.3 million more people will be uninsured by 2034. Most states will not enforce their rules for months yet; when they do, they will be working from Nebraska’s example — both its compliance numbers and its disputed cases.
The desk cannot settle McCreary’s account against the state’s; the records each side cites do not meet. What the record does show is a system that moved eight months early, kept coverage for most of the people it touched, and left at least one cancer patient believing, at the worst moment of his year, that he had lost his. Both of those things are the story.
Catalina Clarke
Editor-in-Chief, The Library Media
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