Nebraska's early Medicaid work rules leave a cancer patient without coverage
A 64-year-old Omaha man with kidney cancer was told his Medicaid had ended under Nebraska's early work requirements, forcing canceled appointments unless he paid, as the state's rollout strains its call centers and raises questions about who is being cut off.
A 64-year-old Omaha man with kidney cancer was told by his hospital that he had lost Medicaid coverage, and that his appointments would be canceled unless he paid. Eli McCreary's case has become a focal point in the debate over Nebraska's early rollout of new Medicaid work rules, which the state began enforcing on May 1, eight months ahead of most other states.
CHI Health, the hospital system treating McCreary, informed him that his coverage had lapsed. When he called the state's call center, a representative told him that Medicaid now required work he had not met. McCreary, who also lives with diabetes and COPD, said his substance use treatment had ended in March. He has no online Medicaid portal account, and he may have missed letters the state sent about the change.
The rules stem from President Donald Trump's One Big Beautiful Bill Act, which requires certain adult Medicaid recipients to meet an 80-hour monthly work requirement. Roughly 70,000 adults in Nebraska are subject to it. The law includes exemptions for people with serious illness and for those in treatment for substance use disorder. McCreary may have qualified for one of those exemptions, according to the reporting, but was not treated as eligible when his coverage was questioned.
State officials say the early results are encouraging. They report that 86 percent of affected applicants either met the requirement or qualified for an exclusion, and that 93 percent of existing enrollees kept their coverage. Advocates dispute that the rollout has been handled well, arguing that the figures do not show how many people were wrongly flagged or how quickly those errors were corrected. Internal state documents, according to the reporting, show that most early denials were tied to paperwork that had not been submitted.
The strain is visible in the state's phone lines. Nebraska received more than 101,000 calls in August, a 66 percent increase from May. The average wait time for callers roughly doubled, rising from 13 minutes to 26 minutes between May and July. Gov. Jim Pillen has said the state will not add workforce to handle the surge, and a hiring freeze has been in place since July.
Nebraska budgeted $8.2 million over two years for outside contractors to help run the program. Among them are Public Consulting Group and Covendis. Some of those firms have been paid more than $250,000 each, and one has been paid more than $1.8 million. The spending has drawn attention at a time when the state is cutting its own staffing capacity to answer questions from enrollees.
The changes come as work requirements prepare to spread nationwide. They begin next year in more than 40 states. The Congressional Budget Office estimates that the policy could leave 5.3 million more people uninsured by 2034. Democrats in Congress have said they plan to move to repeal the changes in January, though any repeal would face a likely veto from Trump.
For McCreary, the immediate concern is continuing treatment for kidney cancer while the question of his coverage is resolved. His experience illustrates the gap that critics say exists between the rules on paper and how they operate for people with complex medical needs, who may be the least able to navigate online portals, paperwork and long phone queues.
Source: fortune.com
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