On Saturday, August 1, about 200 Nebraskans will lose their Medicaid coverage for not meeting the state's new work requirements. They are the first people in the country to be dropped under the rules created by last year's federal budget law, according to reporting from NPR and Tradeoffs, and for families in the other 43 states facing the same requirements, what happens in Nebraska over the next few weeks is a preview of what's coming to their own mailboxes.

For families who rely on Medicaid, the practical question has shifted from whether the rules survive the lawsuits to what to do when a termination notice arrives.

Why Nebraska, and Why Now

Federal law gives states until January 1, 2027 to start enforcing the new requirements, which apply to non-disabled adults in the Medicaid expansion group. Nebraska chose to start eight months early, a decision the OpenSky Policy Institute has tracked since the state announced it. About 70,000 Nebraskans are subject to the requirements, and Governor Jim Pillen has estimated that roughly 30,000 could lose coverage in the years ahead. Nationally, around 20 million people in 44 states will need to meet the same test.

The requirement itself: 80 hours a month of work, volunteering, education, or job training, or monthly income of at least $580. A federal judge in Boston declined to pause the rules on July 30, so the calendar is running everywhere, not just in Nebraska.

Nebraska's Medicaid director, Drew Gonshorowski, told Tradeoffs the state built in safeguards before letting any termination go out. "We've ensured that we have extra steps in place making sure we review any denial multiple times before it goes out the door," he said. "We don't want folks falling through the cracks on this."

The reporters tested that promise by calling the state's Medicaid help line. They found long waits, a dropped call, and trouble reaching the Spanish-language line. The state says its average wait is 10 minutes. Both things can be true, and the lesson for families is the same either way: don't rely on a phone call alone. Follow up in writing, keep copies, and note the date and name every time you talk to the agency.

Exemptions Exist, but They Aren't Automatic

The law exempts people with disabilities and serious illness, parents caring for children 13 or younger, and caregivers of people with disabilities. On paper, most readers of this site fall on the protected side of the line.

In practice, the exemption has to be recognized before it protects anyone. The federal rule requires many people to document that they qualify as medically frail, and that standard is narrower than families expect. A diagnosis by itself may not settle it. The strongest position is a file you've built before the state asks: a provider letter describing the condition and how it limits work or reporting, SSI or SSDI award letters, IEP or waiver documentation, anything that shows caregiving responsibilities.

The Appeal Is the Whole Ballgame

Gonshorowski said he will be watching one number as coverage losses begin: how many people appeal. "I view this as the ultimate bellwether on whether or not you got your process right on implementation," he said.

Federal Medicaid rules give you up to 90 days to request a fair hearing after a termination notice, and if you request the hearing before the termination date on the notice, your coverage generally continues while the appeal is decided. Your notice will list the exact deadline, and that date is the single most important line on the page. In Nebraska, Disability Rights Nebraska can help with appeals at no cost, and every state has a protection and advocacy organization that does the same.

An appeal does two things at once. It protects your family's coverage, and it creates the signal the state's own director says he's watching for. If the process wrongly dropped someone, the appeal is how the record shows it.

What Families Everywhere Can Do This Month

Every state must begin notifying Medicaid members about the new requirements by August 31, so a letter is likely on its way to you no matter where you live. Before it arrives: make sure your address and phone number are current with your state Medicaid agency, gather the exemption documentation described above, and read anything the state sends for its response deadline. Our earlier coverage of Nebraska's rollout walks through the documentation steps in detail.

The 200 people losing coverage this weekend are the beginning of a process that reaches every expansion state within five months. Nebraska families who appeal now protect their own coverage and show the rest of the country where the process breaks, while there is still time to fix it.