On July 1, 2025, Nebraska Senator Pete Ricketts cast one of the 50 votes that passed the One Big Beautiful Bill Act, whose Medicaid work requirement he could have stopped by voting no, after voting against a motion to remove its work-reporting paperwork. He voted to confirm Mehmet Oz and Robert F. Kennedy Jr., whose agencies wrote the rule that carries the requirement out.
Nebraska became the first state to implement a key pillar of the requirement, and between May and August 2026 at least 1,090 Nebraskans lost Medicaid or were denied it, most of them for missing paperwork rather than for not working. Ricketts has written that Nebraska led the nation on the requirement. As governor, his administration made Nebraskans wait another 18 months for the Medicaid expansion voters approved in 2018.
What the Work Requirement Pete Ricketts Voted For Has Cost Nebraskans on Medicaid
- Coverage lost. State figures released on September 29, 2026 show that the number of Nebraskans losing coverage or being denied coverage at application is at least 1,090 (so far), counting new applicants from May and renewals from July through August. KFF's reading of the same data: 14% of new applicants and 7% of individuals renewing coverage had their applications denied or lost coverage for not meeting the requirement.
- Paperwork denials. Of the Nebraskans who lost coverage at renewal, 92% were denied for failing to provide requested information, Georgetown University's Center for Children and Families found, and among applicants, Most of the 557 denied applications were due to non-response to requests for additional information.
- Patients. Eli McCreary, 64, told Human Rights Watch he lost his Medicaid coverage while undergoing treatment for kidney cancer, and at an Omaha-area health center a pregnant woman arrived for a prenatal appointment and learned she no longer had Medicaid coverage, though pregnancy exempted her; staff had to fight to restore it.
- People at risk. Nebraska had about 72,000 expansion enrollees when the requirement began, and the Urban Institute projects that Nebraska's enrollment could decline by between 16,000 and 30,000 people in 2028.
- Hospitals. Hospitals warned that about 30% to 40% of the 70,000 Nebraskans on Medicaid expansion would need their work status checked by hand, adding paperwork for patients and staff.
Pete Ricketts's Votes, Confirmations, Governor's Record and Statements on Nebraska Medicaid
- Ricketts Cast One of the 50 Votes for the Law That Created the Medicaid Work Requirement. On July 1, 2025, Pete Ricketts voted yes on passage of H.R. 1, which passed 50 to 50 with the Vice President breaking the tie, so the work requirement would not have become law had he voted no. The requirement is the law's largest Medicaid cut, $326 billion and 5.3 million more uninsured by 2034, according to the Congressional Budget Office, and states must start it no later than January 1, 2027.
- Ricketts Voted Against Removing the Work-Reporting Paperwork and the Medicaid Cuts in June 2025. On June 30, 2025, Ricketts voted no on Senator Chris Coons's motion to remove provisions that strip people of federal benefits through the creation of new administrative burdens and paperwork requirements; it failed 48 to 52. The same day he voted no on Senator Ron Wyden's motion to strike any provision that cuts funding for Medicaid, which failed 47 to 53. Paperwork is how most Nebraskans have lost coverage so far: 92% of those dropped at renewal were denied for failing to provide requested information.
- Ricketts Voted Against Repealing the Six-Month Medicaid Checks in January 2026. On January 30, 2026, Ricketts voted no on Senator Bernie Sanders's amendment to repeal the law's six-month eligibility checks for expansion adults and its new cost sharing (Congressional Record); it failed 49 to 51. The six-month checks begin with renewals on or after December 31, 2026 and add 700,000 uninsured by 2034, so Nebraskans covered under expansion will have to prove their eligibility twice a year.
- Ricketts Voted to Confirm Mehmet Oz and Robert F. Kennedy Jr., Whose Rule Narrowed the Exemptions. On April 3, 2025, Ricketts voted to confirm Mehmet Oz as administrator of the Centers for Medicare and Medicaid Services, after voting on February 13 to confirm Robert F. Kennedy Jr. as secretary of health and human services. Their June 2026 rule projects that enrollment would be reduced by 2.3 million individuals in FY 2027 and, KFF reports, defined “ medical frailty ” more narrowly than states expected, so a health condition exempts a person only if it keeps them from meeting the requirement. A federal judge refused to block it, so the rule stays in effect while the underlying lawsuit continues.
- As Governor, Ricketts's Administration Delayed Voter-Approved Medicaid Expansion by 18 Months. After Nebraska voters approved Medicaid expansion in November 2018, Governor Pete Ricketts's administration set October 1, 2020 as the start date, and low-income Nebraskans who qualified will have to wait another 18 months to get it, the Associated Press reported in April 2019. When coverage began, Most newly eligible Nebraskans will start with the Basic benefits package, without dental, vision or over-the-counter drugs, which his administration tied to a waiver requiring at least 80 hours a month of several community engagement activities. Nebraska Appleseed's lawsuit said the state would lose approximately $149 million in federal funding by delaying implementation, by the advocates' estimate. The two-tier design lasted one year: DHHS announced in 2021 that expansion enrollees will receive equal benefits coverage, including dental services, vision services from October 1, 2021.
- Ricketts Praised the Work Requirement and Said Nebraska Led the Nation on It. Ricketts's July 1, 2025 release on the bill said it Establishes community engagement requirements for able-bodied adults. In a July 17, 2026 column he wrote, "We placed work and eligibility requirements on Medicaid and SNAP" and "Nebraska led the nation on these reforms." At the September 1, 2026 State Fair debate he said, "We also put in work requirements so that that 20-something-year-old guy" would have to work, study or volunteer. Nebraska began cutting people off on August 1, 2026, when the state's Medicaid director said roughly 200 Nebraskans will lose their coverage in the first round.
- Ricketts Wrote That the Law Preserves Medicaid for Those Who Need It; Exempt Nebraskans Lost Coverage. In an August 15, 2025 column, Ricketts wrote: "We are strengthening and preserving Medicaid for those who need it." The Urban Institute found that under the federal rule many people in compliance with or exempt from the requirement would still lose coverage, and in Nebraska a cancer patient who could not work and a pregnant woman who was exempt both lost Medicaid in 2026, Human Rights Watch reported.
Frequently Asked Questions About Pete Ricketts on Nebraska Medicaid work requirement
What is Pete Ricketts's record on Nebraska's Medicaid work requirement under Trump?
Pete Ricketts cast one of the 50 votes that passed the One Big Beautiful Bill Act, which created the Medicaid work requirement, and voted against removing its paperwork rules and against repealing its six-month checks. He voted to confirm Mehmet Oz and Robert F. Kennedy Jr., whose rule carries it out, and he has praised Nebraska for going first. In its first four months at least 1,090 Nebraskans lost or were denied coverage.
Does Pete Ricketts support Nebraska starting the Medicaid work requirement early?
Yes. Pete Ricketts wrote in July 2026 that Nebraska led the nation on the requirement. Nebraska announced it would start enforcing it on May 1, 2026, eight months before the January 1, 2027 deadline in the law Ricketts voted for, and the first Nebraskans were cut off on August 1, 2026.
How many Nebraskans have lost Medicaid under the work requirement Pete Ricketts voted for?
Under the work requirement Pete Ricketts voted for, at least 1,090 Nebraskans lost Medicaid or were denied it between May and August 2026, by the state's first figures. Advocates expect the number to grow as renewals continue; the Urban Institute projects 16,000 and 30,000 fewer Nebraskans enrolled by 2028.
What did Pete Ricketts do about Medicaid expansion as Nebraska governor?
Pete Ricketts's administration, after Nebraska voters approved expansion in 2018, set a start date that made qualifying Nebraskans wait another 18 months, and then started most new enrollees on a Basic benefits package without dental or vision care. In 2019 he said K-12 education, higher education and property tax relief could be on the chopping block to make room for the state's share of the cost.
Last updated: 2026-10-25