2026年5月1日 美国东部时间10:30 / 美国有线电视新闻网（CNN）
作者：塔米·勒比
（资料图）2025年7月8日，内布拉斯加州州长吉姆·皮伦在华盛顿农业部举行的新闻发布会上发言，介绍美国农业部《国家农场安全行动计划》。
曼努埃尔·巴尔塞·塞纳塔/美联社/资料图
内布拉斯加州将于本周五开始在医疗补助计划中实施工作要求，成为首个落实共和党“宏伟美好法案”核心条款的州。
共和党籍州长吉姆·皮伦曾表示，这项强制规定将促进长期独立。但社区倡导者和专家担心，由于文书负担和其他障碍，数万符合资格的低收入成年人可能会失去医保覆盖。他们还批评该州在法律规定的截止日期前八个月就实施这项要求，没有为参保者提供足够的通知或信息，也没有雇佣更多人员来监管这项新规定。
内布拉斯加州约有7万人通过医疗补助扩展计划获得医保覆盖，该计划于2018年经选民投票表决通过。但根据左翼智库城市研究所的分析，由于这项工作要求，以及一项新的联邦规定——各州必须每六个月而非每年重新审核医疗补助扩展计划参保者的资格，到2028年该州参保人数可能减少1.6万至3万人。
《宏伟美好法案》于去年7月由美国总统唐纳德·特朗普签署成为法律，首次在医疗补助计划中引入联邦层面的工作要求，实现了共和党长期以来的目标。该法案规定，19岁至64岁申请或已获得医疗补助扩展计划覆盖的成年人，每月必须工作、做志愿活动、上学或参与工作项目至少80小时。豁免人群包括孕妇、14岁以下儿童的父母、身体虚弱者以及正在接受物质使用障碍治疗的人员。
这项规定适用于已全部或部分向更多低收入成年人扩大医疗补助覆盖的42个州，以及哥伦比亚特区。城市研究所预计，到2028年，全美参保人数将减少300万至700万。
在内布拉斯加州，通过医疗补助扩展计划申请医保的人员必须证明，他们在申请前一个月符合该项要求，或者符合豁免资格。对于现有参保者，该州将于7月31日开始在其续保期间核查工作要求。参保者必须满足工作要求，或在上次续保以来的一个月内符合豁免资格。
内布拉斯加州将利用多种数据源来确定部分参保者是否已经达到足够的工作时长，或符合豁免资格。如果月收入至少达到580美元，也可满足该项要求，这相当于按联邦最低工资标准工作80小时的收入。
但其他参保者必须提供更多就业信息，或声明自己正在做志愿活动、在校就读、参与工作项目、身体虚弱或符合其他特定豁免条件。该声明表格需要填写志愿组织、工作项目和医生等的联系方式。
“对部分人来说，将面临沉重的文件证明障碍，”医疗补助计划与无保险人群项目副主任詹妮弗·托尔伯特说道，“这意味着，即便有些人确实符合要求，也可能因为无法提供证明文件而无法参保；即使已经参保，也可能因为无法提供文件而失去医保覆盖。”
倡导组织内布拉斯加苹果种子项目的医疗保健获取项目主管萨拉·马雷什表示，参保者对这项工作要求非常困惑。许多人不知道这项新规定是否适用于自己，也不清楚自己是否符合诸如身体虚弱之类的豁免资格。她说，该州没有开展足够的宣传活动，且已发出的通知模糊难懂。
“这项仓促上马的工作将造成大量伤害，”马雷什说道。
内布拉斯加医院协会在4月中旬发布的一份声明中表示，医院和医疗保健提供商也担心“突然实施”这项规定可能导致大量患者失去医保覆盖，治疗中断，尤其是在农村地区。医疗服务提供者正准备应对潜在的经济损失和行政负担的增加。
负责监管医疗补助计划的内布拉斯加州卫生与人类服务部表示，他们已经加大了宣传力度，并通过发送数万封邮件、电子邮件和短信通知参保者。该部门还希望通过电视、广播和社交媒体活动提高公众 awareness。
“我们的首要任务是确保参保者清楚了解项目的变化以及如何维持医保覆盖，这也是为什么卫生与人类服务部致力于在每一步都进行沟通并提供支持，”医疗补助与长期护理司司长德鲁·贡肖夫斯基在4月初的一份新闻稿中说道。
Tens of thousands could lose Medicaid coverage as Nebraska becomes first state to implement GOP work requirement
May 1, 2026, 10:30 AM ET / CNN
By Tami Luhby
FILE – Nebraska Gov. Jim Pillen, speaks during a news conference at the Department of Agriculture to rollout the USDA’S National Farm Security Action Plan in Washington, July 8, 2025.
Manuel Balce Ceneta/AP/File
Nebraska is launching work requirements in Medicaid on Friday, becoming the first state to implement a key pillar of the Republicans’ “big, beautiful bill.”
GOP Gov. Jim Pillen has said the mandate will promote long term independence. But community advocates and experts fear that tens of thousands of eligible low-income adults could lose their coverage due to paperwork burdens and other hurdles. They also criticize the state for enacting the requirement eight months before the deadline set by the law, failing to provide enrollees enough notice or information and opting not to hire more staff to oversee the new mandate.
Roughly 70,000 Nebraskans are covered through Medicaid expansion, which voters approved at the ballot box in 2018. But enrollment could decline by between 16,000 and 30,000 people in 2028 due to the work requirement, as well as a new federal provision that states must redetermine expansion enrollees’ eligibility every six months instead of every year, according to an analysis by the left-leaning Urban Institute.
The One Big Beautiful Bill Act, which President Donald Trump signed into law last July, enacted the first-ever federal work requirement in Medicaid, fulfilling a longtime Republican goal. It mandates that adults ages 19 through 64 who sign up for or are covered by Medicaid expansion work, volunteer, attend school or participate in a work program at least 80 hours a month. Among those who are exempt are pregnant women, parents of children under age 14, medically frail individuals and those in substance use disorder treatment programs.
The provision applies to 42 states that have fully or partially expanded Medicaid coverage to more low-income adults, as well as to the District of Columbia. In total, enrollment will decline between 3 million and 7 million people in 2028, the Urban Institute projects.
In Nebraska, those signing up for coverage through Medicaid expansion will have to show they meet the requirement in the month before they apply or that they qualify for an exemption. For existing enrollees, the state will start checking work requirements when they renew their coverage, starting July 31. They must meet the work mandate or qualify for an exemption for one month since their last renewal.
Nebraska will use various data sources to determine whether some enrollees are already working enough hours or qualify for an exemption. They can also meet the mandate if they earn at least $580 a month, which is equal to working 80 hours at the federal minimum wage.
But other participants will have to provide more information about their employment or attest that they are volunteering, enrolled in school or a work program, are medically frail or meet certain other exemptions. The declaration form asks for contact information for volunteer organizations, work programs and doctors, among others.
“For some people, there is going to be a significant documentation hurdle,” said Jennifer Tolbert, deputy director of the Program on Medicaid and the Uninsured. “That could mean those individuals, even though they are meeting the requirements, are simply not able to enroll because they can’t provide the documentation, or if they are enrolled, could still lose coverage because of the inability to provide the documentation.”
Enrollees are incredibly confused about the work requirement, said Sarah Maresh, health care access program director at Nebraska Appleseed, an advocacy group. Many don’t know whether the new mandate applies to them or whether they qualify for exemptions like being medically frail. The state is not doing enough outreach, she said, and the notices it has sent are vague and difficult to understand.
“This rush job will lead to a lot of harm,” Maresh said.
Hospitals and healthcare providers are also concerned that the “sudden implementation” could result in many patients losing coverage and suffering disruptions in care, especially in rural areas, the Nebraska Hospital Association said in a release in mid-April. The providers are bracing for potential financial losses and increases in administrative burdens.
The state Department of Health and Human Services, which oversees Medicaid, said it has increased its outreach efforts and is notifying enrollees by sending tens of thousands of mail, email and text messages. It also hopes to raise awareness through television, radio and social media campaigns.
“Our top priority is making sure members clearly understand changes to the program and how to maintain their coverage, which is why DHHS is committed to communicating and providing support every step of the way,” Drew Gonshorowski, director of the Division of Medicaid and Long-Term Care, said in a press release in early April.
