State disputes cancer patient’s account of lost Medicaid coverage
Nebraska began enforcing its Medicaid work requirements on May 1, becoming the first state to enforce them under President Trump’s signature One Big Beautiful Bill Act, eight months before most states were scheduled to do so. About 70,000 adult Medicaid recipients in Nebraska are subject to the rules. They must prove they are working or participating in a similar activity for 80 hours a month unless they qualify for an exemption. State officials and consultants advising the state said the May 1 date was challenging to meet.
Eli McCreary, an Omaha, Nebraska, resident who had recently been diagnosed with kidney cancer, said he got a call from a local hospital run by CHI Health and was told he was not insured anymore under Medicaid. He said the hospital would cancel his appointments unless he paid out of pocket. McCreary, who was 64 at the time, said he phoned a call center for help and was told his benefits under Medicaid — the government health program for people with low incomes or disabilities — now required that he have a job. “You’re required to do work to stay on,” McCreary said a representative told him. “And you haven’t fulfilled your work requirement.”
For decades, McCreary said, he has battled drug addiction. A substance use treatment program discharged him in March, and in June he was diagnosed with cancer in his right kidney, according to documents reviewed by KFF Health News. He also has diabetes and chronic obstructive pulmonary disease. The four-month treatment course began in November 2025.
“I don’t understand what job I can get,” McCreary said. “I can’t walk. I can hardly breathe. I can’t move around. What job am I going to get?”
McCreary said the call-center worker did not have a good explanation for why the work requirements would apply to him. Before his health deteriorated, McCreary worked as a driver for an asphalt services company, and he said he worked “until I couldn’t do the job anymore.” “I really had hoped to work longer,” he said. “I kind of enjoyed that job.”
McCreary said he canceled a CT scan and other tests at the hospital, which is part of CommonSpirit Health, the nation’s largest Catholic health system. He also delayed a cancer-related appointment with a physician who travels back and forth to Omaha. “I missed my window of opportunity with him for another month,” he said. Taylor Miller, a spokesperson for CHI Health, declined to answer questions about McCreary’s experience. In an emailed statement, she said that “CHI Health is committed to helping patients understand their health care coverage and access to care, including available financial assistance resources.”
When he received the call from the hospital about his coverage, “I was really in despair,” McCreary said. Eventually, he said, he called for help. “This cancer ain’t going to stop just because I ain’t got insurance,” he said. “It’s going to keep working on me.”
Jeff Powell, a spokesperson for Nebraska’s Department of Health and Human Services, maintained McCreary experienced “no lapses in coverage.” Powell said McCreary was disenrolled from Medicaid after turning 65 and had aged out of Medicaid into Medicare before the work requirements could be applied to him. Powell also said McCreary qualified for Medicaid through the Affordable Care Act and therefore fell within the population subject to the new rules. Despite what McCreary said he was told, Powell said Medicaid work requirements were not the reason he lost coverage.
Attorneys and policy professionals who work with people on Medicaid and other public benefit programs said McCreary’s substance-use treatment, lasting four months starting in November 2025, and his other health conditions should have exempted him. Federal law outlines categories of exemptions, such as being too sick to work, and people considered too ill include those with a serious medical condition or a substance use disorder. Gelila Selassie, director of health advocacy for the nonprofit Justice in Aging, said McCreary’s care should not have been disrupted.
McCreary said he had heard about the Medicaid work requirements but did not know they might apply to him. He did not have an account on Nebraska’s online Medicaid portal and preferred to handle things over the phone or in person, and he said it was possible he missed letters from Nebraska Medicaid about his coverage. Nebraska’s health department said it sent tens of thousands of letters, text messages and emails to inform enrollees about the new requirements. According to state documents, Nebraska said it would “implement enhancements” to its computer system and online portal, including allowing people to submit documents online and having “clear, plain-language” enrollee notices. “I don’t know if it’s my fault or not,” McCreary said.
Nebraska’s health department runs AccessNebraska, a call center for help with safety net benefits such as Medicaid and the Supplemental Nutrition Assistance Program, commonly known as food stamps. The number McCreary recalled dialing turned out not to be AccessNebraska; it was for a different call center, one for SNAP accounts that Nebraska outsources to a private company. Powell said the state had no record of McCreary calling the health department.
Powell said the rollout “has been very successful.” He pointed to state data showing 86% of affected applicants met the requirement or qualified for an exclusion and 93% of existing enrollees kept their coverage. Health clinics and organizations advocating for poor and working-class Nebraskans say the rollout has been rife with problems, many due to poor training and inadequate staffing.
Nebraska Gov. Jim Pillen said in December that state officials “certainly appreciate President Trump and his whole administration for delivering this key reform.” Pillen spoke alongside a videoed-in Mehmet Oz, the Trump administration official overseeing Medicare and Medicaid. “We’re excited to be able to be the first to make it happen,” the Republican governor said. Laura Strimple, a spokesperson for the governor, did not respond to requests for comment.
As of August, roughly 1,100 Nebraskans had been denied benefits because of Medicaid work requirements, and most denials were because people did not respond to requests for information. Internal health-department documents obtained through a public-records request showed that, as of early July, most work-requirement denials among Nebraska adults applying for Medicaid resulted from unsubmitted paperwork. The state wrote that this was “expected.” Nebraska’s total Medicaid enrollment declined by roughly 4,600 people, or 1.4%, from May through an August report.
Advocates who work with Medicaid enrollees in Nebraska say participants are confused and do not know whether the rules apply to them, and they say enrollees also have gotten inaccurate information. In December, Pillen said the state “won’t be adding workforce” to implement the work requirements.
Nebraska budgeted $8.2 million over two years for contractor costs associated with Medicaid changes, including work requirements and more frequent eligibility checks. The costs stem from two companies Nebraska uses to increase agency staffing: Public Consulting Group, based in Boston, and Atlanta-based Covendis, which supplies information-technology workers. Nebraska operates its own information-technology system that determines who in the state qualifies for Medicaid, unlike most states, which outsource the work to companies under contracts often worth hundreds of millions of dollars. But Nebraska’s health department nonetheless relies on the private sector to help administer its Medicaid program.
Covendis executives did not respond to requests for comment. Powell said the health department “uses contracted staff when hiring a state employee is either uneconomical or impractical because of time constraints, or when the role requires highly specialized skill sets.”
Nebraska listed at least half a dozen contractors costing more than $250,000 each, including one person whose compensation exceeds $1.8 million, the documents show. Nebraska submitted the records to federal Medicaid regulators as part of a routine process to secure federal money. Powell said the funding requests “may not reflect actual expenditures.” Sarah Maresh, a program director with the social justice advocacy nonprofit Nebraska Appleseed, said the amounts were “shocking.” “When you put in complicated policies like this, there are large corporations making money behind the scenes,” Maresh said. “This just further confirms that it’s happening in Nebraska quietly.”
Federal taxpayers will largely bear the costs of implementing the One Big Beautiful Bill Act’s Medicaid policies in Nebraska and elsewhere. Congress allocated $200 million in one-time funding to states. Under federal regulations, the U.S. government picks up most of the tab for state information-technology changes, paying as much as 90% of the cost.
The Medicaid work requirements in the One Big Beautiful Bill Act and other changes shepherded by Republicans will curtail insurance gains that came from the Affordable Care Act, also known as Obamacare, according to the reporting. The Congressional Budget Office estimated that the Republican tax-and-spending law would reduce federal Medicaid spending by more than $900 billion over a decade, and it adds reporting requirements and restrictions that make it harder for people to stay enrolled.
Nebraska’s average wait time at a health-department call center nearly doubled between May and July, rising from about 13 minutes to 26 minutes before declining in August. The state received more than 101,000 calls in August, a 66% increase from May. Advocates for Medicaid enrollees said they had encountered people who had waited on the phone for hours.
The reporting noted that there are experiences the official data may not catch, such as what happened to McCreary — saddled with figuring out what happened with his Medicaid benefits amid a health crisis, and whether it was even true that he had to work to keep them. It said his case underscores the fallout from being caught in confusing government systems and silos that are not obvious to the public.
Kenny McMorris, CEO of the Charles Drew Health Center, a federally qualified health center in North Omaha, said roughly half of the center’s 13,385 patients were on Medicaid and 42% of those patients were subject to the work requirements. “If people are working, they just don’t have time to be sitting on the phone to go through all of this stuff,” McMorris said. He added, “You can leverage the technology, but you still got to have people there to help.” Advocates criticized Pillen’s decision not to add workforce to implement the requirement. Separately, Pillen instituted a government-wide hiring freeze in July.
Public Consulting Group senior consultant Latanya Michaux praised Nebraska’s implementation in a post on the company’s website, saying, “I really cannot brag enough about how well Nebraska handled this requirement,” and crediting the firm’s “incredible relationship” with the state. Public Consulting Group said it worked with the state to develop new guidance and “process guides” — materials for Nebraska eligibility workers with instructions on how to process Medicaid applications or renewals — and training materials for Nebraska caseworkers reviewed by KFF Health News refer to those guides. “The training was very robust, and the process guides were very robust,” Michaux said. Public Consulting Group also helped the state institute changes to Nebraska’s Medicaid information-technology system, according to the company. “We are preparing for future updates and enhancements,” Michaux said.
Maresh disagreed with that characterization. “There are gaps” in the state’s training materials, she said, and caseworkers “are confused” about work requirements. Public Consulting Group spokesperson Alyssa Brown said the company “has supported Nebraska Medicaid via a broad range of consulting services since 2019, including work on federal and state compliance initiatives.” She said Michaux had “discussed” the state’s process guides at a conference but Nebraska developed them. Brown also said the company did not develop the training.
At an August panel discussion during a national conference in Oregon, Nebraska and federal officials, as well as consultants advising the state, detailed the difficulties and the successes of the May 1 launch. Federal and state officials said Nebraska had to implement the law before the Centers for Medicare & Medicaid Services had issued regulations detailing exemptions; the agency issued those regulations on June 1. Because CMS had not yet issued regulations outlining key details such as how people could get exemptions, Nebraska officials said they had to rely on the law’s broad language to make initial decisions.
“They said, ‘We’re going to go live May 1.’ To which CMS said, ‘Oh, my God!’” Brent Weaver, an official who specializes in Medicaid information technology at the U.S. Centers for Medicare & Medicaid Services, said about Nebraska. Nebraska officials knew “they weren’t as agile as they probably would have liked to have been,” Weaver said, “but they didn’t let that stop them.” “If they fail, we looked at it as a failure,” he added, in comments that broadly praised the state’s approach. CMS did not answer questions from KFF Health News about Nebraska’s rollout and Weaver’s remarks.
Michaux said a group of 60 people held hours-long meetings three days a week that were “very exhausting.” “Our calendars were cleared, and that was the focus,” she said. “Even though it was not so easy,” Michaux said at the conference, “we definitely had fun standing up the Medicaid work requirement program.” Jacob Kawamoto, a deputy director at Nebraska’s Medicaid division, said, “We had to get comfortable being uncomfortable.”
The One Big Beautiful Bill Act’s Medicaid changes are the most complicated in years — changes that government benefit experts say will strain and exacerbate long-standing problems with state technology systems for health benefits. “It’s already a shaky system, and now you’ve added more burdens on top of that,” said Gelila Selassie, director of health advocacy for the nonprofit Justice in Aging.
Next year, work requirements will apply to millions of adult Medicaid enrollees in more than 40 states. The nonpartisan Congressional Budget Office estimated the policy will lead to 5.3 million more people being uninsured in the United States by 2034. Democrats holding newly elected majorities in Congress said they plan to repeal the Medicaid changes during their first 100 hours in office in January, though it was unclear whether they would succeed because President Trump could veto the legislation.
McCreary is now enrolled in Medicare, with Medicaid covering some of his health costs, and he was able to reschedule his canceled appointments. “The cancer has grown so much,” he said. He had surgery in early November to remove his right kidney. His account of the hospital call remains in conflict with Nebraska officials’ account of why his Medicaid coverage ended. KFF Health News correspondent Samantha Liss contributed to this report.