Eli McCreary of Omaha, Nebraska, said he had recently been diagnosed with kidney cancer when he got a call from a local hospital run by CHI Health. He said he was informed that he wasn\u2019t insured anymore under Medicaid \u2014 and that the hospital would cancel his appointments unless he paid out-of-pocket.<\/p>\n
McCreary, who was 64 at the time, said he phoned a call center for help. He said he was told his benefits under Medicaid, the government health program for people with low incomes or disabilities, now required that he have a job.<\/p>\n
\u201cYou\u2019re required to do work to stay on,\u201d McCreary said a representative told him. \u201cAnd you haven\u2019t fulfilled your work requirement.\u201d<\/p>\n
For decades, McCreary said, he has battled drug addiction. A substance use treatment program discharged him in March, and in June he was diagnosed with cancer in his right kidney, according to documents reviewed by KFF Health News. He also has diabetes and chronic obstructive pulmonary disease.<\/p>\n
\u201cI don\u2019t understand what job I can get,\u201d McCreary said. \u201cI can\u2019t walk. I can hardly breathe. I can\u2019t move around. What job am I going to get?\u201d<\/p>\n
McCreary said he canceled a CT scan and other tests at the hospital, which is part of CommonSpirit Health, the nation\u2019s largest Catholic health system. He also delayed a cancer-related appointment with a physician who travels back and forth to Omaha. \u201cI missed my window of opportunity with him for another month,\u201d he said.<\/p>\n
Taylor Miller, a spokesperson for CHI Health, declined to answer questions about McCreary\u2019s experience. In an emailed statement she said that \u201cCHI Health is committed to helping patients understand their health care coverage and access to care, including available financial assistance resources.\u201d<\/p>\n
Determined to be the first state to enforce Medicaid work requirements under President Donald Trump\u2019s signature One Big Beautiful Bill Act, Nebraska launched the new rules May 1 \u2014 eight months before most states will do the same. With their newly elected majorities in Congress, Democrats have said they plan to repeal the changes to Medicaid in their first 100 hours in office in January. But it is unclear whether they will be successful, because Trump could veto the measure.<\/p>\n
Nebraska Gov. Jim Pillen said in December<\/a> that state officials \u201ccertainly appreciate President Trump and his whole administration for delivering this key reform.\u201d Pillen spoke alongside a videoed-in Mehmet Oz, the Trump administration official overseeing Medicare and Medicaid.<\/p>\n \u201cWe\u2019re excited to be able to be the first to make it happen,\u201d the Republican governor said.<\/p>\n Laura Strimple, a spokesperson for the governor, didn\u2019t respond to requests for comment. Jeff Powell, a spokesperson for Nebraska\u2019s Department of Health and Human Services, said its rollout \u201chas been very successful.\u201d He pointed to state data showing<\/a> 86% of affected applicants met the requirement or qualified for an exclusion and 93% of existing enrollees kept their coverage.<\/p>\n Health clinics and organizations advocating for poor and working-class Nebraskans say the rollout has been rife with problems \u2014 many due to poor training and inadequate staffing.<\/p>\n About 70,000<\/a> adult Medicaid recipients in Nebraska are subject to the work requirements. They must prove they\u2019re working or participating in a similar activity for 80 hours a month, unless they qualify for an exemption. State officials and consultants advising them have said the May 1 date was challenging to meet.<\/p>\n To deploy the law\u2019s Medicaid coverage restrictions, Nebraska budgeted millions of dollars for government contractors, according to state documents KFF Health News obtained via a public records request. Documents from Nebraska\u2019s health department outline $8.2 million in contractor costs to enact Medicaid changes, including work requirements and more frequent checks for whether people still qualify.<\/p>\n Nebraska operates the information technology system that determines who in the state qualifies for Medicaid, unlike most states, which outsource the work<\/a> to companies under contracts often worth hundreds of millions of dollars. But Nebraska\u2019s health department nonetheless relies on the private sector to help administer its Medicaid program.<\/p>\n The $8.2 million in costs span two years. They stem from two companies that Nebraska uses to increase agency staffing: Public Consulting Group, based in Boston, and Atlanta-based Covendis, which supplies information technology staffers.<\/p>\n One of the companies has praised Nebraska\u2019s implementation of work requirements. A post<\/a> on Public Consulting Group\u2019s website quotes senior consultant Latanya Michaux. \u201cI really cannot brag enough about how well Nebraska handled this requirement,\u201d Michaux said, crediting the firm\u2019s \u201cincredible relationship\u201d with the state.<\/p>\n Covendis executives did not respond to requests for comment. Powell said the health department \u201cuses contracted staff when hiring a state employee is either uneconomical or impractical because of time constraints, or when the role requires highly specialized skill sets.\u201d<\/p>\n Advocates who work with Medicaid enrollees in Nebraska say that participants are confused and don\u2019t know whether the rules apply to them. These advocates say enrollees also have received inaccurate information. In December, Pillen said the state \u201cwon\u2019t be adding workforce\u201d to implement the work requirements, a decision those advocates have criticized. Pillen in July also instituted a government-wide hiring freeze.<\/a><\/p>\n Nebraska listed at least half a dozen contractors costing more than $250,000 each, including one person whose compensation exceeds $1.8 million, the documents show. Nebraska submitted the records to federal Medicaid regulators as part of a routine process to secure federal money. Powell said the funding requests \u201cmay not reflect actual expenditures.\u201d<\/p>\n Sarah Maresh, a program director with the social justice advocacy nonprofit Nebraska Appleseed, said the amounts were \u201cshocking.\u201d<\/p>\n \u201cWhen you put in complicated policies like this, there are large corporations making money behind the scenes,\u201d Maresh said. \u201cThis just further confirms that it\u2019s happening in Nebraska quietly.\u201d<\/p>\n Confusion and Longer Wait Times<\/strong><\/p>\n The Medicaid work requirements in the One Big Beautiful Bill Act and other changes shepherded by Republicans will curtail insurance gains that came from the Affordable Care Act, also known as Obamacare. The GOP tax and spending law, which the Congressional Budget Office estimated would reduce federal Medicaid spending by more than $900 billion over a decade, adds reporting requirements and restrictions making it harder for people to stay enrolled.<\/p>\n As of early July,\u00a0 most denials related to the work requirements among Nebraska adults applying for Medicaid were due to unsubmitted paperwork, according to internal documents<\/a> from Nebraska\u2019s health department that KFF Health News obtained through a public records request. The state wrote this was \u201cexpected.\u201d<\/p>\n State data shows that average wait times at a Nebraska health department call center nearly doubled<\/a> between May and July, going from about 13 minutes to 26 minutes, before declining in August. In interviews, advocates for Medicaid enrollees said they\u2019ve encountered people who have waited on the phone for hours.<\/p>\n Nebraska received more than 101,000 calls<\/a> in August, a 66% jump from May.<\/p>\n \u201cIf people are working, they just don\u2019t have time to be sitting on the phone to go through all of this stuff,\u201d said Kenny McMorris, CEO of the Charles Drew Health Center, a federally qualified health center in North Omaha. He said roughly half of Charles Drew\u2019s 13,385 patients are on Medicaid, and of those, 42% are in the population subject to the work requirements.<\/p>\n \u201cYou can leverage the technology, but you still got to have people there to help,\u201d McMorris said.<\/p>\n Then there are experiences the official data may not catch, like what happened to McCreary \u2014 saddled with figuring out what happened with his Medicaid benefits amid a health crisis, and whether it was even true that he had to work to keep them.<\/p>\n McCreary had heard about the Medicaid work requirements but didn\u2019t know they might apply to him. Powell confirmed McCreary was eligible for Medicaid because of the ACA \u2014 putting him in the population subject to work requirements.<\/p>\n His ordeal underscores the fallout from being caught in confusing government systems and silos that aren\u2019t obvious to the public.<\/p>\n \u201cThis cancer ain\u2019t going to stop just because I ain\u2019t got insurance,\u201d he said. \u201cIt\u2019s going to keep working on me.\u201d<\/p>\n When he received the call from the hospital about his coverage, \u201cI was really in despair,\u201d McCreary said. Eventually, he said, he called for help.<\/p>\n For decades, McCreary said, he has battled drug addiction. A substance use treatment program discharged him in March, and in June he was diagnosed with cancer in his right kidney, according to documents reviewed by KFF Health News. He also has diabetes and chronic obstructive pulmonary disease. (Chris Machian for KFF Health News)<\/p>\n Nebraska\u2019s health department runs AccessNebraska, a call center for help with safety net benefits such as Medicaid and the Supplemental Nutrition Assistance Program, commonly known as food stamps. But the number McCreary recalls dialing ended up not being AccessNebraska \u2014 it was for a different call center, one for SNAP accounts that Nebraska outsources to a private company. Powell said the state has no record of McCreary calling the health department.<\/p>\n McCreary said the worker didn\u2019t have a good explanation for why the Medicaid work requirements would apply to him. Before his health deteriorated, McCreary worked as a driver for an asphalt services company. He said he worked \u201cuntil I couldn\u2019t do the job anymore.\u201d<\/p>\n \u201cI really had hoped to work longer,\u201d he said. \u201cI kind of enjoyed that job.\u201d<\/p>\n Attorneys and policy professionals who work with people on Medicaid and other public benefit programs said that McCreary\u2019s substance use treatment, lasting four months starting in November 2025, and other health conditions should have exempted him.<\/p>\n The federal law outlines categories of exemptions, such as being too sick to work. People who are considered too ill include those who have a serious medical condition or a substance use disorder.<\/p>\n Nebraska\u2019s health department said it sent<\/a> tens of thousands of letters, text messages, and emails to inform enrollees about the new requirements. According to state documents, Nebraska said it would \u201cimplement enhancements\u201d to its computer system and online portal, including allowing people to submit documents online and having \u201cclear, plain-language\u201d enrollee notices. McCreary, however, doesn\u2019t have an account on Nebraska Medicaid\u2019s online portal, preferring to handle things over the phone or in person.<\/p>\n He also said it\u2019s possible he missed letters from Nebraska Medicaid about his coverage.<\/p>\n \u201cI don\u2019t know if it\u2019s my fault or not,\u201d McCreary said.<\/p>\n The Cornhusker State\u2019s experience could be a harbinger of things to come. Next year, work requirements will apply to millions of adult Medicaid enrollees in more than 40 states.<\/p>\n The nonpartisan Congressional Budget Office has estimated the policy will lead to 5.3 million more people being uninsured in the U.S. by 2034.<\/p>\n \u2018We Definitely Had Fun\u2019<\/strong><\/p>\n The One Big Beautiful Bill Act\u2019s Medicaid changes are the most complicated in years \u2014 changes that government benefit experts say will strain and exacerbate long-standing problems<\/a> with state technology systems for health benefits.<\/p>\n \u201cIt\u2019s already a shaky system, and now you\u2019ve added more burdens on top of that,\u201d said Gelila Selassie, director of health advocacy for the nonprofit Justice in Aging.<\/p>\n Nebraska and federal officials, as well as consultants advising the state, detailed the difficulties and successes with the state\u2019s May 1 launch during an August panel discussion at a national conference in Oregon.<\/p>\n \u201cThey said, \u2018We\u2019re going to go live May 1.\u2019 To which CMS said, \u2018Oh, my God!\u2019\u201d Brent Weaver, an official who specializes in Medicaid IT at the U.S. Centers for Medicare & Medicaid Services, said about Nebraska.<\/p>\n Nebraska officials knew \u201cthey weren\u2019t as agile as they probably would have liked to have been,\u201d Weaver said, \u201cbut they didn\u2019t let that stop them.\u201d<\/p>\n \u201cIf they fail, we looked at it as a failure,\u201d he added in comments that broadly praised the state\u2019s approach.<\/p>\n CMS did not answer\u00a0questions from KFF Health News about Nebraska\u2019s rollout and Weaver\u2019s remarks.<\/p>\n In Nebraska, a group of 60 people held hours-long meetings three days a week that were \u201cvery exhausting,\u201d Michaux, of Public Consulting Group, said during a different session at the conference.<\/p>\n \u201cOur calendars were cleared, and that was the focus,\u201d Michaux said.<\/p>\n Because CMS had not yet issued regulations outlining key details such as how people could get exemptions \u2014 it would do so June 1 \u2014 Nebraska officials said they had to rely on the law\u2019s broad language to make initial decisions.<\/p>\n \u201cWe had to get comfortable being uncomfortable,\u201d Jacob Kawamoto, a deputy director at Nebraska\u2019s Medicaid division, said at the conference.<\/p>\n Public Consulting Group said it worked with the state to develop new guidance and \u201cprocess guides\u201d<\/a> \u2014 materials for Nebraska eligibility workers with instructions on how to process Medicaid applications or renewals. Training materials for Nebraska caseworkers reviewed by KFF Health News refer to those guides.<\/p>\n \u201cThe training was very robust, and the process guides were very robust,\u201d Michaux said.<\/p>\n Maresh disagreed with that characterization. \u201cThere are gaps\u201d in the state\u2019s training materials, she said, and caseworkers \u201care confused\u201d about work requirements.<\/p>\n Public Consulting Group also helped the state institute changes to Nebraska\u2019s Medicaid IT system, according to the company<\/a>. \u201cWe are preparing for future updates and enhancements,\u201d Michaux said.<\/p>\n In response to questions, Public Consulting Group spokesperson Alyssa Brown said the company \u201chas supported Nebraska Medicaid via a broad range of consulting services since 2019, including work on federal and state compliance initiatives.\u201d She said Michaux \u201cdiscussed\u201d the process guides at the conference but Nebraska developed them. Similarly, Brown said the company did not develop training.<\/p>\n Federal taxpayers will largely bear the costs of implementing the One Big Beautiful Bill Act\u2019s Medicaid policies in Nebraska and elsewhere. Congress allocated $200 million in one-time funding to states. Under federal regulations, the U.S. government picks up most of the tab for state IT system changes, paying as much as 90% of the cost.<\/p>\n \u201cEven though it was not so easy,\u201d Michaux said at the conference, \u201cwe definitely had fun standing up the Medicaid work requirement program.\u201d<\/p>\n Public Consulting Group\u2019s employees, Brown told KFF Health News, are \u201cpassionate about public service and helping our clients improve the lives of the people they serve.\u201d<\/p>\n Dropping Medicaid Enrollment<\/strong><\/p>\n As of August, roughly 1,100 Nebraskans<\/a> had been denied benefits because of Medicaid work requirements. Most denials were because people did not respond to requests for information.<\/p>\n Nebraska\u2019s total Medicaid enrollment has declined by roughly 4,600 people since May, a drop of 1.4%, according to an August report<\/a>.<\/p>\n As for McCreary, the Nebraska health department\u2019s Powell maintained he experienced \u201cno lapses in coverage\u201d and said he was disenrolled from Medicaid after turning 65. Despite what McCreary said he was told, Powell said, Medicaid work requirements weren\u2019t the reason: He aged out of Medicaid and into Medicare before they could be applied to him.<\/p>\n Selassie, of Justice in Aging, said McCreary\u2019s care shouldn\u2019t have been disrupted.<\/p>\n McCreary is now enrolled in Medicare, and Medicaid covers some of his health costs. He was able to reschedule his canceled appointments.<\/p>\n \u201cThe cancer has grown so much,\u201d he said.<\/p>\n He had surgery in early November to remove his right kidney.<\/p>\n McCreary is now enrolled in Medicare, and Medicaid covers some of his health costs. (Chris Machian for KFF Health News)<\/p>\n KFF Health News correspondent Samantha Liss contributed to this report.<\/em><\/p>\n Have you tried to prove your eligibility for Medicaid under new rules that require people to show they are working, going to school, or participating in another qualifying activity? Click here<\/a>\u202fto contact KFF Health News.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/em><\/p>\n This article<\/a> first appeared on KFF Health News<\/a> and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License<\/a>.<\/p>","protected":false},"excerpt":{"rendered":" Eli McCreary of Omaha, Nebraska, said he had recently been diagnosed with kidney cancer when he got a call from a local hospital run by CHI Health. He said he was informed that he wasn\u2019t insured anymore under Medicaid \u2014 and that the hospital would cancel his appointments unless he paid out-of-pocket. McCreary, who was…<\/p>\n","protected":false},"author":0,"featured_media":16629,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-16628","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/16628"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=16628"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/16628\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/media\/16629"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=16628"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=16628"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=16628"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}