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In a letter on Thursday, the Trump administration issued guidance that would enable states, for the first time in the program's history, to impose work requirements in order for individuals to receive Medicaid, according to reports.

Ten states - Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin - have already sent in proposals for work requirements for Medicaid, according to CMS, which is part of the U.S. Department of Health and Human Services. The policy responds to numerous state requests to test programs through Medicaid demonstration projects under which work or participation in other community engagement activities - including skills training, education, job search, volunteering or caregiving - would be a condition for Medicaid eligibility for able-bodied, working-age adults. "A study examining Michigan's Medicaid expansion found that almost seven in 10 enrollees who were working said they performed better at work once they got Medicaid coverage".

The agency is encouraging states to align their Medicaid work requirements with those mandated by other federal safety net programs.

The CMS guidance gives states a great deal of flexibility to define their own exceptions to a work requirement, as well as what counts toward work.

President Donald Trump is making it possible for conservative states to apply work requirements to Medicaid recipients.

As of October 2017, almost 75m individuals were enrolled in Medicaid and the children's health insurance program (Chip).

CMS said the work and community engagement policy is for working-age, non-pregnant Medicaid beneficiaries who are not eligible for Medicaid on the basis of a disability. Almost eight in 10 recipients live in families with at least one member in employment, according to the study.

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"So I think you take those recommendations, embed it in, put it back on the Governor's desk and let him explain to taxpayers why people who are capable of working are not working", said Rep. Seth Grove, (R) - York County.

It is not clear how many people will be affected by the new rules. Jane Hudson, executive director of the organization, said she is concerned about what would constitute a disability.

The move is already amassing vocal critics.

For instance, the guidance notes that some Medicaid recipients may have trouble meeting these requirements because of poor health, substance abuse or high unemployment in their areas. Those who have a job, are in school or care for young children will need to document to their state's Medicaid agency that they are in compliance - or risk losing their benefits. For low-wage workers, such as waitresses with fluctuating wages, "it boggles my mind", Stewart said.

The federal government reimburses a portion of the money spent by states to provide Medicaid coverage for those who are eligible. She was an architect of Kentucky's waiver application once a Democratic governor who had eagerly embraced the ACA was succeeded by Matt Bevin, a Republican who campaigned on a pledge to reverse the program expansion there. That could include job training, career planning or volunteer activities. IN rewrote its waiver request last summer, this time asking for federal permission to compel work activities.

Verma also had a major role in designing an unorthodox approach to Medicaid in IN, which had asked the Obama administration to approve a work requirement.

The new regulations' supporters argue that it's a common sense idea.