Medicaid eligibility rules are changing nationwide; an Omaha cancer patient's coverage scare shows how notices and exemption records can diverge in practice.
What Happened in Nebraska
In a report published November 9, NPR/KFF Health News correspondent Rachana Pradhan described the experience of Eli McCreary, an Omaha resident who was 64 when he was diagnosed with kidney cancer in June. McCreary said a CHI Health hospital told him his Medicaid coverage had ended and that a call-center representative said he had not fulfilled a new work requirement. He said he delayed some cancer-related appointments after being told he might have to pay out of pocket. The NPR/KFF Health News report describes his account and the state’s response.
Nebraska DHHS disputed that the work rule caused a coverage lapse. The department said McCreary had no lapse in coverage and was disenrolled from Medicaid after turning 65 and moving into Medicare. It also said the work requirement was not applied to him and that the state had no record of his call to the department. The report found that McCreary had dialed a SNAP call center, rather than AccessNebraska, the state’s call center for Medicaid and other benefits.
The report also said attorneys and policy professionals who work with Medicaid enrollees believed McCreary’s recent substance-use treatment and other health conditions should have qualified him for an exclusion. This is the report’s account of what those sources said; it is not a VerifiedAgent determination about his eligibility or coverage history.
The episode illustrates how different records and agencies can produce conflicting explanations for a coverage problem. A hospital billing office, a SNAP call center and a state Medicaid agency may not have the same information or authority to resolve an eligibility question. Confusion about which office issued a notice can make it difficult to identify the reason for a decision.
Which Medicaid Enrollees May Be Affected
Nebraska began enforcing the new Medicaid work requirements on May 1, 2026, eight months ahead of the federal deadline. The requirements generally concern certain adults enrolled in the Medicaid expansion group and some people covered through qualifying waiver programs. They do not apply to every person with Medicaid. Groups such as children, pregnant people and many people enrolled through other eligibility categories may be outside the affected population or covered by an exception.
Under the federal rule, an affected adult generally must meet a qualifying activity standard or qualify for an exception or exclusion. The CMS interim final rule sets a January 1, 2027 implementation deadline for states, unless a state has started earlier or receives an allowed delay.
The federal rule lists qualifying activities that include:
- Working at least 80 hours in a month.
- Completing at least 80 hours of community service or participating in a qualifying work program for at least 80 hours.
- Attending an educational program at least half-time.
- Combining qualifying activities to meet the monthly hour threshold.
- Having monthly household income at least equal to the federal minimum wage multiplied by 80 hours. At the current federal minimum wage, that is $580 per month. Seasonal workers may qualify using an average monthly income calculation.
Specific state procedures and verification methods may vary. Available records should be checked with the state Medicaid agency.
Exclusions and Medical Frailty
The rule includes exclusions for specified groups, including certain parents, guardians, caretakers or family caregivers of a child under 14 or a disabled person; veterans with a qualifying disability rating; people who are medically frail or have special medical needs; people in substance-use treatment; pregnant and postpartum people; and certain other categories. The criteria are specific. A person’s status should be independently confirmed with the state agency.
A cancer diagnosis does not, by itself, automatically establish a medical frailty exclusion. The federal rule’s medical frailty provision covers specific categories, including serious or complex medical conditions and substance use disorders. The circumstances of a diagnosis, treatment and functional limitations may be relevant to an eligibility review. The state’s applicable process and any current court ruling should also be confirmed.
On November 2, KFF summarized a ruling in Massachusetts v. Oz. Judge Richard Stearns of the U.S. District Court for the District of Massachusetts ruled that CMS exceeded its authority by requiring people to prove a condition significantly impaired their ability to meet the activity requirement in order to qualify as medically frail. KFF described a six-month period for states that were parties to the lawsuit to update systems and noted that an appeal was expected. The KFF summary of the ruling explains the decision and its implementation implications. State systems may take time to reflect legal changes; the rule and the status of any proceedings should be checked for updates.
What Nebraska’s Early Numbers Show
KFF’s analysis of Nebraska’s initial data through August found that, among applicants subject to the requirement, 46% met qualifying activities, 39% qualified for an exclusion, and 14% had applications denied. Among enrollees whose renewals were subject to the requirement, 93% kept coverage and 7% lost it. Of the 533 renewal cases that lost coverage, 92% did not respond to paperwork requests. These figures are reported in KFF’s Nebraska analysis.
The renewal loss figure does not show that every person who lost coverage was found to be affirmatively out of compliance. Most losses in that group followed non-response to a verification request. A person may be eligible for an exclusion or may meet an activity requirement but still lose coverage if a request is missed, misunderstood or not returned in time.
That distinction matters when interpreting early rollout statistics. Administrative disenrollment can reflect paperwork and communication barriers as well as eligibility decisions. McCreary’s account, alongside DHHS’s statement that he had no coverage lapse and had aged into Medicare, shows why aggregate program numbers may not capture the practical effects of separate agency records and call centers.
Nebraska has also reported increased demand for assistance: the NPR/KFF Health News story reported that average call-center wait times nearly doubled from May to July and that August call volume exceeded 101,000. The state’s early experience will not determine how every state’s system operates, but it identifies issues to monitor as implementation expands.
A Notice Checklist for a Medicaid Renewal
Consider a 58-year-old adult in a state beginning implementation on January 1, 2027, with a renewal due in February. The actual review month, applicable requirements and procedures depend on state policy. If a notice arrives, the following steps can help identify what the agency is requesting:
- Check the sender and program. Confirm whether the notice is from the state Medicaid agency, another benefits agency or a health care provider. A SNAP call center or hospital billing office may not be able to confirm a Medicaid eligibility decision.
- Get the request in writing. Keep the full notice, including the date, the agency name, the information requested, the submission methods and the response deadline. If an explanation was given by phone, ask the appropriate agency to provide or confirm it in writing.
- Identify the issue and months reviewed. Determine whether the notice concerns a renewal, a qualifying activity, a possible exclusion, or another Medicaid eligibility rule. For a notice of non-compliance, the federal rule provides 30 calendar days from receipt to make a satisfactory showing. Follow the deadline and instructions on the actual notice.
- Raise possible exclusions promptly. Tell the Medicaid agency about relevant circumstances, such as medical frailty, qualifying caregiving, a qualifying veteran disability or participation in substance-use treatment. Ask what information the state needs to assess the specific category. Submit available evidence early rather than waiting until the response period is nearly over.
- Ask about a short-term hardship exception. States may offer exceptions for specified circumstances. These can include some hospital or nursing facility stays, certain disasters or high-unemployment areas, and travel outside the community for necessary treatment of a serious or complex condition. Availability and request procedures depend on state policy.
- Keep submission records. Save copies of forms and supporting documents, and retain confirmation numbers, delivery receipts or screenshots when available. Record the date, agency and outcome of calls.
- Ask about review rights and next steps. If the notice says coverage may end, ask the issuing agency about reconsideration, appeal rights, other eligibility categories and what to do if the deadline has passed.
This checklist is procedural information, not a determination of eligibility. A state Medicaid agency is the source for an individual’s current case status.
What to Watch as Requirements Expand
Nebraska’s experience is an early indicator of the administrative work involved in putting new eligibility rules into practice, not a forecast for every state. The federal deadline brings implementation to states that have not started early, while legal challenges concerning the medical frailty exclusion add another layer of uncertainty. System changes, notice design and state guidance may not all update at the same time.
KFF’s Nebraska analysis also notes that the state’s current use of self-declaration is temporary. Under the CMS rule, starting January 2028, states generally must request documentation when reliable information is unavailable, with separate treatment for medical frailty. Changes in verification can affect how enrollees document an activity or exclusion and may change renewal outcomes.
For Medicaid eligibility questions, the key distinction is between what a notice says, what an agency has verified and what the enrollee’s current case record shows. A coverage status should be confirmed with the state Medicaid agency, and any deadline in a written notice should be treated as time-sensitive.