Nebraska sent its Medicaid work-requirement notice to enrollees in December 2025. Montana’s followed in April 2026. The Centers for Medicare & Medicaid Services did not issue the federal interim final rule that eventually governed the content of those notices until June 1, 2026, publishing it in the Federal Register two days later. Both states had already put their letters in the mail months before the rule they were supposedly following even existed.
Two States That Moved Before Washington Finished the Rule
Nebraska and Montana are unusual among the states covered by the new Medicaid work requirement because both had already begun implementing it before most of the country. CMS’s own fact sheet on the rule notes states could choose to start the requirement earlier than the general January 1, 2027 deadline, and Nebraska and Montana used that flexibility, which meant their notice clocks started running on an entirely different, earlier schedule than the one the interim final rule would eventually set for everyone else.
That head start is why a KFF review of state outreach materials singles both states out: they are the only two, according to the July 2026 brief, that had to write and mail their first work-requirement notices with no interim final rule to follow, because none existed yet. The rule that finally arrived was itself published in the Federal Register on June 3, 2026, running 135 pages, and it took effect on July 31, 2026, roughly seven months after Nebraska had already mailed its notice and three months after Montana had mailed its own.
Free retirement updates: Miss an enrollment or claim deadline and it may be gone. Our free Retirement Shield newsletter keeps readers ahead of the ones that matter. Get the free newsletter.
What Nebraska’s December Letter Got Right and Left Out
Nebraska’s notice, a three-page mailing reviewed in the KFF brief, covered a lot of ground on its own: it explained Medicaid expansion, described what work requirements are, laid out when and how the state would check compliance, spelled out the consequences of not complying, and listed exemptions. It also included information on reporting life changes that could affect eligibility, pointed enrollees toward job-seeking help, and gave contact information for the state Medicaid agency. What it did not do, because the federal rule requiring it did not exist yet, was tell enrollees how many months the state would look back to verify compliance. That disclosure is now a specific requirement under CMS’s interim final rule, which means Nebraska’s earliest notice recipients received a letter that would not, on its own, satisfy today’s federal content standard.
Montana’s Head Start Through a State Plan Amendment
Montana took a different administrative route to the same early start, using a state plan amendment to implement work requirements ahead of the general timeline. That amendment itself specified what the state’s notices had to say and required Montana to send them by April 2026, two months before CMS issued its rule. The content Montana’s amendment required was similar in spirit to what the eventual federal rule asks for: an explanation of the work requirement, how to comply, and what happens for noncompliance. But KFF’s comparison found gaps there too. Unlike the interim final rule, Montana’s state plan amendment did not explicitly require the notice to spell out which activities count toward compliance, who qualifies for an exemption, who is affected in the first place, or how many months the state would look back. Montana separately sent a broader letter to all Medicaid enrollees in March 2026 pointing people to the state’s work-requirements website, but that mailing was a general awareness piece rather than the formal notice the rule now defines.
Why Getting There Early Doesn’t Mean Getting It Finished
Being first came with a real tradeoff for both states: neither had a finished federal template to work from, so neither could fully anticipate what CMS would eventually decide belonged in a compliant notice. That leaves an open question the KFF brief doesn’t resolve, which is whether Nebraska, Montana, or both will need to send a second, corrected notice to the same enrollees now that the interim final rule’s specific content list, including the look-back disclosure both states’ early letters lacked, is in effect. For everyone else, the practical lesson is different: the 42 other jurisdictions sending their first notices this summer and fall are working from a finished rule Nebraska and Montana never had, so their letters should not carry the same gaps by design.
For a Nebraska or Montana household that already received one of these early letters, the safest read is to treat it as a starting point rather than the final word. The core facts in each state’s early notice, that the work requirement is coming and roughly what it will demand, have not changed. What’s missing is the newer, more specific detail the federal rule now requires, particularly the exact look-back window each state will use to check compliance. Calling the state Medicaid agency to ask directly which months will count, rather than assuming the original letter already covers it, is the one step the KFF comparison suggests both states’ earliest recipients may still need to take.
This article was produced with AI assistance and reviewed by a human editor. Figures are linked to their primary sources; where a claim could not be verified from the public record, we say so.
More Financial Reading
