Nebraska has begun ending Medicaid coverage for some adults who do not meet new work, education, volunteering or training requirements, becoming the first state to put the federal policy into effect. The rollout is closely watched because it offers an early indication of how Trump’s nationwide work-rule mandate may affect low-income Americans’ access to healthcare.

The rules apply to non-disabled, non-pregnant adults aged 19 to 64 covered through Medicaid expansion, unless they qualify for an exemption or hardship. Enrollees generally must complete 80 hours of qualifying activity in one month, attend school at least half-time, or earn at least $580; the state is reviewing coverage at renewal and says it will use existing data before asking people for documentation. Nebraska has roughly 70,000 Medicaid-expansion members, and earlier estimates suggested 20,000 to 28,000 might need to provide further information.