Americans have officially started to lose their Medicaid coverage as new so-called “work requirements” kick in under the big Republican tax and spending law passed by Congress last summer.Most states will begin to remove people from the government-run health insurance program for low-income and disabled people starting Jan. 1, 2027.But Nebraska is getting an early start. It terminated coverage for roughly 200 people this month.Dan Gorenstein is the founder and executive editor of Tradeoffs, a nonprofit news organization that covers health policy. He’s been following this story and recently spoke with Nebraska’s Medicaid director.He shared what he heard with “Marketplace Morning Report” host Nova Safo. The following is an edited transcript of the conversation.Nova Safo: Can you start by reminding us what these new work requirements are and who they apply to?Dan Gorenstein: Sure. The new requirements apply to roughly 20 million adults in 44 states who are part of the so-called “Medicaid expansion population.” These are generally low-income adults without kids. And starting Jan. 1, this group will have to prove that they are working or volunteering 80 hours per month — or that they're in school or job training — just to have coverage. Now, some folks are exempt, like people with disabilities, parents of young children, and caregivers. Supporters point out the change should save taxpayers more than $300 million over the next decade. That's largely due now to anywhere from 3 million to 8.5 million people losing their insurance by 2028, because of this new rule. Those estimates include people who are already working or exempt, but are expected to get tripped up by paperwork.Safo: So a big change requiring lots of new infrastructure and communication. States are racing to get everything ready by the Jan. 1 deadline. But Nebraska is starting months early, as I understand it. You talked to the state's Medicaid director, Drew Gonshorowski, for a recent story. What did he say about why they are moving so quickly on this?Gorenstein: A big part of it was Gonshorowski’s confidence in his state's tech systems. Nebraska already has a lot of data on people's income and health status. He says that has allowed the state to confirm that about 75% of folks in Nebraska are in compliance without even having to ask them for any additional information. Gonshorowski also believes, like many conservatives do, that requiring people to work is an incentive to help them out of poverty.Drew Gonshorowski: We have this new data stream in our program that does give us an opportunity to look to that membership and say, "OK, what do you want your purpose to be? How can we help you?” And I think that that is, amidst all this controversy, one of those great opportunities in this implementation, is for states to start to use that data for good, too.Gorenstein: That said, critics in Nebraska and across the country are far more skeptical. They say lots of people are confused or unaware of the new requirements, and they expect eligible people will fall through the cracks, lose coverage, and get sicker.Safo: Now, if we zoom out from Nebraska, more than two dozen Democratic-led states are suing the Trump administration over something called “medical frailty.” Can you explain what that case is all about?Gorenstein: So, of the groups that are exempt from the work requirements, are people who are “medically frail” — effectively too sick to work. Most states were planning to look at people's health records for things like cancer or hospital stays to confirm this, but federal officials surprised the states in June by telling them that patients would need to provide proof, like a doctor's note or something. This will require a lot more work from states and people on Medicaid. There's widespread concern that this would press already stretched-thin state Medicaid programs and lead to even more people losing coverage, even though they are eligible. A hearing on the case is scheduled for Oct. 20.