State officials remain unsure how to enforce a requirement for many adult Medicaid enrollees to show they’re working — even as one state launches its program this week.

Nebraska became the first state on Friday to implement the federal Medicaid work requirements, mandated under President Donald Trump's tax and spending bill that passed last summer.

Now, around 70,000 adults below the age of 65 in Nebraska who have Medicaid through its expansion could risk having their health insurance ripped away from them.