5 stories
Drew Gonshorowski has resigned as director of Nebraska's Division of Medicaid and Long-Term Care after less than two years, as the state became the first to implement more aggressive Medicaid work requirements. The leadership change comes at a critical juncture for Nebraska's program. The timing and circumstances of the resignation were not detailed in available reporting. A new director will need to oversee ongoing implementation of the work requirement policy and address any operational challenges in the state's Medicaid program.
Federal officials approved a temporary hardship exemption from Nebraska's Medicaid work requirements for Dawson County following the closure of a Tyson Foods plant that eliminated approximately 3,000 jobs. Governor Jim Pillen directed the state Department of Health and Human Services to request the exemption last month. The waiver temporarily suspends work requirement compliance for affected Medicaid enrollees in the county. This represents a significant operational accommodation for managed care organizations serving the region, as they will need to adjust eligibility tracking and member communications during the exemption period.
The Trump administration notified state Medicaid directors last week that it will implement more stringent financial oversight of Section 1115 demonstration waivers. The changes affect the waiver process that states use to design and operate Medicaid pilot programs and demonstrations. CMS sent letters to state Medicaid directors announcing the new oversight requirements. The policy shift represents increased federal scrutiny of state demonstration projects, which often include managed care delivery system reforms and coverage expansions.
Nebraska Governor Jim Pillen has directed the state's Department of Health and Human Services to request federal approval for a temporary high-unemployment exemption from Medicaid work requirements in Dawson County. The county recorded the state's highest unemployment rate in April. The waiver request would suspend work requirement enforcement in the county while the broader state policy remains in effect. Federal approval from CMS is required before the exemption can take effect.
Nebraska became the first state to implement federally mandated Medicaid work requirements in May 2026. CMS released an interim final rule this week outlining requirements all states must follow by January 1, 2027. Nebraska DHHS is reviewing the federal rule but declined to pause its current implementation. The state's approach will serve as an early test case for other states preparing to comply with the federal mandate.
Get the daily briefing.