Nebraska's early Medicaid work rules leave a cancer patient scrambling for care

Nebraska, first to enforce Medicaid work rules, says the rollout is working, but one 64-year-old with kidney cancer was told his coverage had ended.

Eli McCreary, 64, of Omaha, had recently been diagnosed with kidney cancer when a CHI Health hospital told him his Medicaid coverage had ended. The hospital said it would cancel his appointments unless he paid out of pocket. He canceled a CT scan and other tests and put off an appointment with a physician by about a month. CHI Health declined to answer questions about his case.

Nebraska began enforcing Medicaid work requirements on May 1, the first state to do so under the One Big Beautiful Bill Act and eight months ahead of most states. About 70,000 adult recipients must show 80 hours a month of work or a similar activity unless exempt. Federal law exempts people too sick to work, including those with a serious medical condition or substance use disorder. Attorneys and policy professionals say McCreary's substance use treatment and health conditions, which include diabetes and COPD, should have qualified him. He was discharged from a treatment program in March and diagnosed with cancer in June.

The case shows how the paperwork can matter as much as the rule. McCreary has no account on the state's online portal and says he may have missed mailed letters. As of early July, most work-requirement denials among adult applicants came from unsubmitted paperwork, which the state called expected. Call-center waits nearly doubled from about 13 minutes in May to 26 in July before easing in August, when calls topped 101,000, up 66% from May. Records show $8.2 million in contractor costs over two years, though a state spokesperson said the figures may not reflect actual spending. When eligible people lose coverage over process, access to care narrows, and treatment can be delayed.

The state calls the rollout very successful, citing data that 86% of affected applicants met the requirement or an exclusion and 93% of existing enrollees kept coverage. McCreary says a call-center worker told him he had not met the requirement. He says he called a SNAP line run by a private contractor, and the state has no record of his call, so his account is unverified. Work requirements will reach millions of enrollees in more than 40 states next year. The Congressional Budget Office estimated the law cuts federal Medicaid spending by more than $900 billion over a decade. Democrats say they will try to repeal the changes in January, but a Trump veto could block that.

Source: KFF Health News