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OMAHA, Neb. — Nebraska on Friday will become the first state to enforce work, volunteer or education requirements for new Medicaid applicants, eight months before the federally mandated requirements kick in.

Advocates worry that the state is launching so rapidly that key details remain unresolved and some people who are eligible for coverage will lose it.

State officials say they’re prepared, training staff and sending letters, emails and texts to people who could be impacted.

Health policy experts, advocates and other states will be watching closely.

“It can be used as a lesson for other states, both where things go well and where things don’t go well,” said Jennifer Tolbert, deputy director of KFF’s Program on Medicaid and the Uninsured.

The law is expected to leave some without insurance

The work requirement is part of a broad tax and policy law that President Trump signed last year. Nebraska Republican Gov. Jim Pillen announced in December that the state would implement it eight months before it was required, saying the aim was “making sure we get every able-bodied Nebraskan to be a part of our community.”

The state had one of the lowest unemployment rates in the U.S. in February: 3.1%.

The federal policy won’t apply to all Medicaid beneficiaries, just those who are enrolled under an expansion that most states chose to make to allow more low-income people to get healthcare coverage.

Under the change, many Medicaid participants ages 19 through 64 will have to show that they work or do community service at least 80 hours a month, or are enrolled in school at least half-time. They’ll also have their eligibility reviewed every six months rather than annually, so they could lose coverage faster if their circumstances change.

Exceptions will be made for people who are too medically frail to work or in addiction treatment programs, among others.

An Urban Institute report from March estimated that the changes would mean about 5 million to 10 million fewer people nationally would be enrolled in Medicaid than would have been otherwise.

Choices states make about how to run their programs are expected to be a major factor in exactly how many people lose coverage.

“The higher the administrative burden, the more likely people are found noncompliant and disenrolled,” said Michael Karpman, who researches health policy at Urban.

Nebraska plans to use data to help determine who qualifies

Not everyone who has coverage will need to submit proof that they’re working.

The state says it will first match enrollees with other data it has to see if participants are working or exempt. The state says it has that information for most of the roughly 70,000 people enrolled in Medicaid through the expansion.

That leaves between 20,000 and 28,000 who would have to provide more information, plus an average of 3,000 to 4,000 new enrollees each month.

At first, they will just need to show that they met the requirements in just one month of the previous 12. The time frame will shift to six months in 2027.

There’s some flexibility. For instance, instead of showing they work 80 hours in a month, someone could instead provide records that demonstrate they earned at least $580, the amount someone earning minimum wage would make in 80 hours.

People who don’t submit requested information within 30 days of being asked could have their applications denied or lose coverage they already have.

The change is causing worry and confusion

Bridgette Annable, who lives in southwest Nebraska, received a letter saying she must meet the work requirements or lose the benefits that pay for her insulin and diabetic supplies.

The 21-year-old mother now has a part-time job, despite being advised against it to protect her mental health. She’s worried about her ability to keep working.

“I am working 30 to 25 hours a week — as much as my employer can provide,” Annable said. “Although I call out of work often due to fibromyalgia pain and bipolar episodes that leave me too tired to leave the house. I have enough energy to take care of my daughter and do some cleaning, but that’s about it.”

Amy Behnke, the chief executive officer of the Health Center Association of Nebraska, said that staff members who help people enroll with Medicaid and their clients have a lot of questions, including some that the state hasn’t yet answered.

Some examples: Apprenticeship programs are supposed to count for work requirements, but does that apply only to those certified by the state’s labor department? There’s an exemption for people who travel to a hospital for care, but there’s not clarity on how far the journey must be.

KFF’s Tolbert noted that the state issued its 295-page list last week of conditions that could qualify someone as medically frail. “We don’t know if it’s a comprehensive list,” she said.

“The speed at which we are choosing to implement work requirements hasn’t left a lot of space for really meaningful communication,” Behnke said.

And Nebraska could have to make changes after the federal government provides guidance that is expected in June.

Mulvihill and Beck write for the Associated Press. Mulvihill reported from Haddonfield, N.J.

A dream team has assembled to bring a scripted series based on the book “Perversion of Justice: The Jeffrey Epstein Story” from the drawing board to the small screen.

Oscar-winning actor Laura Dern has signed on to portray Miami Herald investigative journalist Julie K. Brown, whose tireless reporting on the Epstein sex-trafficking case exposed how federal prosecutors approved what many have referred to as a “sweetheart” plea deal for Epstein in 2008.

Per Variety, the official description of the series reads: “An explosive account of an investigative reporter exposing the secret plea deal between Epstein and federal prosecutors. Drawing from Brown’s experience as a groundbreaking reporter for the Miami Herald, the book and the limited series follow her relentless years-long investigation that identified 80 victims, persuaded key survivors to go on the record, and led to Epstein[‘s] and Ghislaine Maxwell’s arrests.”

In 2008, the financier was charged with luring underage girls to his Palm Beach, Fla., mansion for sex. Under the plea agreement with then-U.S. Atty. for the Southern District of Florida Alexander Acosta, Epstein avoided a federal trial — where, if convicted, he could have faced a potential sentence of life in prison — and pleaded guilty instead to two state felony solicitation charges.

He served 13 months in a county jail but was allowed to go to his office six days a week on a work-release program.

Co-showrunners for the project are Eileen Myers, known for “American Hostage,” and Sharon Hoffman, best known for her work on “House of Cards” and who is adapting Brown’s book for television. Dern will also executive produce, along with Adam McKay and Kevin Messick, known for “The Big Short,” “Don’t Look Up” and “Succession.” Brown is also executive producing.

Although Sony Pictures Television is still pitching the series to networks and streamers, industry insiders predict that, with Dern and McKay on board, a green light is on the horizon.

Last week, Brown joined veteran journalist Katie Couric live on Substack to discuss her reporting on Epstein, and how the disgraced financier and his camp underestimated her. “I don’t think he worried about the little old reporter from the Miami Herald,” she said.

“When you have a sex predator of children who is — at the time I wrote this story, he was out there, you know, he was free — and he was still, as we now know, harming children,” Brown told Couric. “And so my goal at the time was to look at how this happened.

“Where was the breakdown? Was there someone who … was powerful who let him off the hook, and I just thought it was a good time to take a new look at it like a cold case detective would.

“By the time I decided to reopen the case, these women, these victims who were 13, 14, 15 years old, were now in their late 20s and early 30s, and Donald Trump became president right around this time. And ironically, as I was already looking at this story, he nominated Alexander Acosta to be his Labor secretary, and I knew at the time that he was the very person who had let [Epstein] off the hook. And so that’s where I started looking at this case.”

March 26 (UPI) — South Dakota Gov. Larry Rhoden on Thursday signed six election-related bills, including one that requires newly registered voters to prove their citizenship.

The bills, which Rhoden, his administration and the state legislature said are meant to protect the integrity of the state’s elections, also affect campaign finance disclosures, publication of election results, processing of absentee ballots, publication of statewide voter registration files and the submission of nomination petitions.

The voter registration law, called the South Dakota SAVE Act, is one of several that states across the country have been considering as similar legislation has been the subject of heated debate in both the U.S. House and U.S. Senate.

“In South Dakota, we do things right, especially when running out state elections,” Rhoden said in a press release.

“This bill ensures only citizens vote in state elections, keeping our elections safe and secure,” he said.

All six bills that Rhoden signed were named emergencies, which allows them to go into effect immediately, as opposed to July 1, when laws in South Dakota usually go into effect.

This will allow for the requirements to apply to the state’s June 2 primary elections, registration for which has a May 18 deadline, the South Dakota Searchlight reported.

The governor’s office said the state’s SAVE Act applies only to state elections and only to people who are registering to vote in South Dakota for the first time, and will need to show a passport, birth certificate or other document that proves they are a U.S. citizen.

South Dakota residents who are already registered do not need to take any action, and those who need to update their name, address or other information are not required to prove their U.S. citizenship.

“Noncitizens cannot vote in South Dakota — this bill is wholly unnecessary,” South Dakota Democratic state Rep. Erik Muckey said during debate of the bill, The New York Times reported.

Earlier this year, Rhoden also signed into law a bill that would allow voters to challenge the citizenship of other registered voters with a sign, sworn statement and some type of documented evidence.

That law will not take effect before the primary, but it will be effective during the general election in November.