Nebraska’s Medicaid Work Rule Rollout Left a Cancer Patient Fighting for Coverage
Eli McCreary was in the middle of a frightening new diagnosis when the phone call came. He said a hospital tied to CHI Health told him he was no longer insured through Medicaid and that his appointments could be canceled unless he paid out of pocket. The timing could hardly have been worse: McCreary had recently learned he had cancer in his right kidney, and he was trying to arrange tests and specialist visits while also living with diabetes, chronic obstructive pulmonary disease, and a long history of substance use disorder.
The consequences were immediate. He said he canceled a CT scan and other hospital tests, then delayed a cancer-related appointment with a physician who traveled to Omaha. A disease that depends on timely imaging, staging, and treatment planning does not wait for eligibility paperwork to clear.
A Work Requirement That Collided With Severe Illness
Nebraska moved first to enforce the Medicaid work rules created under President Donald Trump’s One Big Beautiful Bill Act, launching the policy on May 1, months before most other states are scheduled to do the same. About 70,000 adult Medicaid recipients in the state are subject to the requirement, which generally calls for 80 hours a month of work or another qualifying activity unless an exemption applies.
McCreary said he did not understand why the rule would apply to him. He was 64 at the time, and he described himself as too short of breath to move around easily and too limited physically to take on a job. He had worked as a driver for an asphalt services company until his health worsened. His illness burden is exactly the kind of clinical profile that complicates work-based eligibility systems: cancer, chronic lung disease, diabetes, and recent substance use treatment all create a high-risk, high-need patient whose life can unravel when coverage is interrupted.
Federal law does include exemptions for people who are too sick to work. Serious medical conditions and substance use disorders are among the categories that can qualify. In McCreary’s case, attorneys and policy professionals who work with Medicaid enrollees said his circumstances should have put him outside the work requirement.
Confusion at the Bedside, Confusion at the Call Center
The state says it sent tens of thousands of letters, text messages, and emails to explain the new rules. It also expanded its computer system and online portal so people could submit documents electronically and receive plain-language notices. Yet McCreary does not use the portal. He said he handles matters by phone or in person, and that reliance on human help is where the system appears to have fractured.
McCreary recalled calling a help line and being told he needed a job to keep Medicaid. He later learned the number he dialed was for a different call center, one for SNAP benefits that Nebraska outsources to a private company. The state said it has no record of him calling the Medicaid help line. Whatever the administrative explanation, the clinical impact was tangible: a patient with active cancer believed his insurance was gone, and his care slowed.
This is where insurance rules stop being abstract policy and become treatment delays. Cancer care relies on coordination across offices, scheduling systems, billing systems, and eligibility systems. If one of those layers fails, the patient absorbs the delay, not the bureaucracy.
Longer Waits and More Paperwork Across the State
Nebraska’s early rollout has been marked by confusion far beyond one patient’s case. As of early July, most denials among adults applying for Medicaid were tied to unsubmitted paperwork, and the state described that outcome as expected. State call-center performance also worsened during the first months after launch: average wait times nearly doubled between May and July, rising from about 13 minutes to 26 minutes before declining in August.
The volume of calls climbed sharply as well. Nebraska received more than 101,000 calls in August, a 66% jump from May. Advocates said some people waited for hours, a problem that lands hardest on patients who work hourly jobs, manage chronic illness, or lack reliable internet access. For patients trying to prove they meet a reporting rule while juggling medications, appointments, and symptoms, even a short phone delay can become a barrier to care.
Kenny McMorris, who leads the Charles Drew Health Center in North Omaha, said roughly half of the center’s 13,385 patients are on Medicaid, and 42% of those patients fall into the group subject to the work requirement. His point was blunt: digital systems may help, but they do not replace staff who can answer questions, troubleshoot documents, and correct errors before coverage disappears.
Millions in Contractor Costs and a System Under Strain
Nebraska budgeted $8.2 million over two years for contractors to help implement the changes, including work requirements and more frequent eligibility checks. The state operates its own information technology system for Medicaid eligibility, unlike most states that outsource those functions, but it still relies on private firms to add staffing and technical support. Public Consulting Group and Covendis are part of that effort, and the documents Nebraska submitted to federal regulators list multiple contractors, including one individual with compensation above $1.8 million.
The numbers point to a policy design that is technically demanding and administratively expensive. Work requirements require states to track exemptions, verify hours, process documents, and update systems quickly when patients’ circumstances change. The more complex the rule, the more likely it is to collide with incomplete records, staffing shortages, and patients who cannot navigate a digital maze while sick.
Public Consulting Group has praised Nebraska’s handling of the rollout. State officials have defended the launch as successful. Yet advocates in the state say beneficiaries are confused, are getting inaccurate information, and are unsure whether the rules apply to them at all.
The Human Cost of an Eligibility Error
McCreary eventually sought help, but the disruption had already changed the course of his care. He said he feared he might have missed letters from Medicaid and did not know whether the problem was his fault. That uncertainty is not a side issue; it is central to how coverage losses harm patients. A person facing kidney cancer should be thinking about staging, treatment options, and symptom control, not whether a phone tree or a mail notice has quietly stripped away the ability to see a doctor.
He said the experience left him in despair. He also said, “This cancer ain’t going to stop just because I ain’t got insurance.”
Nebraska’s rollout is likely to be watched closely because it arrives before similar rules take effect in more than 40 states next year. The Congressional Budget Office has estimated that the policy will leave 5.3 million more people uninsured in the U.S. by 2034. For now, McCreary’s case shows how quickly a work requirement can turn a medical crisis into an administrative one, and how little margin there is when a serious illness meets a brittle benefits system.