The Trump administration has approved a waiver to let Nebraska offer extra benefits to new Medicaid beneficiaries that in turn meet work and wellness requirements.
The waiver, approved Tuesday by the Centers for Medicare & Medicaid Services (CMS), comes as the agency’s efforts to install work requirements in several states have been struck down by federal courts.
Nebraska’s waiver applies to people who are eligible for Medicaid under the Affordable Care Act’s expansion, which the state recently implemented after a successful ballot initiative. Pregnant women, elderly adults, children and disabled adults are not eligible to participate in the program.
Under the program, beneficiaries would get extra benefits including dental, vision and over-the-counter drug medications. In return, the beneficiaries would have to attend an annual health visit and complete a health risk assessment. The beneficiary would also have to maintain affordable employer-sponsored coverage if it is available and not miss more than three scheduled health appointments over six months.
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“The Nebraska demonstration is a unique model designed to provide a voluntary pathway to added benefits for certain adult beneficiaries who participate in wellness activities, as well as work and take part in other community engagement activities,” said CMS Administrator Seema Verma in a statement.
The demonstration will run from Oct. 20 through March 2026 and be implemented next April.
Nebraska estimates that between 41,000 to 51,000 beneficiaries will be enrolled in the demonstration, according to the waiver approval document.
Beneficiaries also must complete at least 80 hours a month of several community engagement activities which include work, enrollment in a college or training program or volunteering.
The framework for the waiver resembles the work requirement programs CMS has approved for 10 states.
The state programs required healthy beneficiaries who got coverage through the Medicaid expansion to complete 20 hours a week of employment, training or volunteering to remain in the program.
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However, only several states have actually implemented the program due to various lawsuits.
Many of the programs have been struck down by federal courts. Arkansas’ program, for instance, which was implemented for a short time, was struck down by a federal judge who found that the program violates the Medicaid statute’s goal of providing insurance coverage to low-income Americans. But helping people get employment doesn’t fall under that goal, the judge said.
Arkansas and the Department of Justice have appealed to the Supreme Court to get lower courts’ rulings overturned. So far, the Supreme Court hasn’t decided whether to take up the case.