Big changes are coming to Medicaid, first in Nebraska, and then in additional states across the country.

Starting in 2026, many states will begin implementing “community engagement” or work requirements for certain adults enrolled in Medicaid. These rules mean that, in order to keep coverage, some people will need to show they are:

• Working
• In school or job training
• Volunteering
• Or participating in other approved activities

But there’s something just as important—and often less discussed:

Some people will not be required to meet these work requirements.

If you’re dealing with substance use or mental health challenges, you may fall into one of those categories.

A quick overview: what’s changing

Under new federal policy changes, states are moving forward with Medicaid work requirements—typically around 80 hours per month of qualifying activity for certain adults.

At the same time, states must allow exemptions for people with certain health conditions.

While the exact language varies, many states—including Nebraska—recognize exemptions for people who are:

• Considered medically frail
• Living with a substance use disorder (SUD)
• Living with a serious mental illness (SMI)
• Participating in treatment for these conditions

 That means your health status—and whether you’re receiving care—can matter when it comes to keeping your coverage.

Why this matters

If you’re not in a place where working or meeting activity requirements is realistic right now, you’re not alone.

These policies are designed with the understanding that some people need care and support before they can meet work expectations.

But there’s an important practical reality:

You may need to show that you qualify for an exemption.

Where Affect fits in

At Affect, we provide evidence-based treatment for substance use disorders, including:

• Medication-assisted treatment (when appropriate)
• One-on-one counseling and support
• App-based tools to help you stay engaged in care
• Care teams that understand both treatment and Medicaid coverage

Our programs are designed to be:

• Accessible from home (telehealth + mobile app)
• Structured and clinically grounded
• Easy to document and verify if needed

For people who are struggling, being in a program like this may be an important step—not just for your health, but also for navigating changes in Medicaid.

Nebraska: What You Need to Know

Nebraska is one of the first states moving forward with work requirements, with implementation beginning May 1, 2026.

You can read the state’s official page here: Nebraska Department of Health and Human Services – Work Requirements

Who the requirement applies to

In Nebraska, many adults in Medicaid expansion may need to:

• Complete about 80 hours per month of qualifying activity
• Show they met the requirement when applying or renewing

Who may qualify for an exemption

Nebraska clearly states that some individuals are exempt.

This includes people who are:

• Considered medically frail
• Living with a substance use disorder
• Living with a serious mental health condition
• Participating in a qualified drug or alcohol treatment program

Source:
https://dhhs.ne.gov/Pages/WorkRequirements.aspx

What this means if you’re struggling

If you’re dealing with alcohol, drugs, or mental health challenges, you may not be required to meet the work requirement in the same way as others.

But—and this matters—you may need to show that you qualify for that exemption.

What counts as treatment?

Nebraska refers to “qualified drug or alcohol treatment programs,” but doesn’t define every detail on one page.

In general, this means:

• You are receiving real clinical care
• From a licensed and recognized provider
• With participation that can be verified if needed

Programs like Affect are designed with this in mind—combining:

• Licensed clinicians
• Structured care plans
• Documented engagement

What you may need to provide

If the state asks for verification, you may need:

• Confirmation that you are in treatment
• Dates or frequency of participation
• Information from your provider

What you can do now

If you’re in Nebraska and on Medicaid:

1. Don’t assume you’re required to meet work hours

Many people qualify for exemptions.

2. If you’re struggling, consider getting support

Substance use and mental health conditions are explicitly recognized.

3. Make sure your situation is documented

Being in a structured, clinical program like Affect’s can make this easier.

4. Stay informed. Check this page frequently for updates: https://dhhs.ne.gov/Pages/WorkRequirements.aspx

A simple next step

If you’re unsure how these changes affect you—or if you’ve been putting off getting help—this may be a good time to explore your options.

At Affect, we help people:

• Start treatment quickly
• Stay engaged over time
• Navigate Medicaid coverage and requirements

(There’s no pressure—just a place to begin.)

Frequently Asked Questions

Do I have to work to keep Medicaid in Nebraska?

Not always. Some people will need to meet work or activity requirements, but others may qualify for exemptions based on health conditions or life circumstances.

Does substance use disorder qualify for an exemption?

Nebraska includes people with substance use disorder and those in treatment programs among those who may qualify for exemptions. Final eligibility depends on individual circumstances.

Does mental health count too?

Yes. Nebraska also references serious mental health conditions as a basis for exemption.

What is a “qualified treatment program”?

The state does not fully define this in one place, but it generally means:

• Licensed and Medicaid-enrolled providers
• Clinical treatment provided by licensed clinicians (not just informal support)
• Ability to verify participation if requested

Does telehealth treatment count?

Yes. Many Medicaid programs—including Nebraska—cover telehealth services. What matters most is whether the care is:

• Clinically appropriate
• Delivered by a recognized provider
• Documented if needed

Can Affect help with this?

Affect provides licensed, Medicaid-enrolled substance use and mental health treatment designed to be accessible and structured. While eligibility decisions are made by the state, participating in a program like Affect’s may help support both your care and documentation needs.

What happens if I don’t meet the requirements?

If you don’t meet work requirements and don’t qualify for an exemption, you could lose Medicaid coverage. That’s why it’s important to understand your options early.

Where can I find official information?

Start here:

https://dhhs.ne.gov/Pages/WorkRequirements.aspx

Final note

Eligibility rules can change, and individual situations vary. This information is based on publicly available guidance from Nebraska and is meant to help you understand your options—not replace official determinations.