UPDATE: One day after announcing states could institute work requirements for Medicaid, Kentucky became the first state to do so as CMS approved its 2016 waiver request. The state now requires able-bodied adult recipients to participate in at least 80 hours per month of “employment activities,” which include jobs training, education and community service.

The Trump administration today released guidance allowing states to add work or job training requirements for entry into the Medicaid health care system.

cms-allows-work-requirement-for-medicaidMedicaid is a state-federal partnership that was expanded under the Affordable Care Act (ACA, or Obamacare) to those making up to 138 percent of the federally defined poverty level, adding millions to the rolls as 31 states joined the program with generous federal funding.

The move today came in the form of new guidance from the Centers for Medicare and Medicaid (CMS), which administers the program started a half-century ago for the neediest Americans.

“Our fundamental goal is to make a positive and lasting difference in the health and wellness of our beneficiaries, and today’s announcement is a step in that direction,” said Seema Verma, the administrator of the federal Centers for Medicare and Medicaid Services.

The new work and job training component was requested by 10 states, mostly Republican led: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin. The work/job training requirement excludes pregnant women, children, the elderly and the disabled.

Democrats were quick to denounce the move. “This action by the Trump administration goes after people who are just trying to get by,” said Democratic U.S. Senator Ron Wyden of Oregon. “Healthcare is a right that shouldn’t be contingent on the ideological agendas of politicians.”

Republicans by and large see the Medicaid expansion as easy to abuse by able-bodied adults and seek to cut federal funding by winnowing the Medicaid rolls.