Kentucky has become the first state to require many of its Medicaid recipients to work to receive coverage, part of an unprecedented change to the nation's largest health insurance program under the Trump administration. The Centers for Medicare and Medicaid Services announced the approval on Friday, reports the AP. The work requirements—which start in July and will last five years—will require adults between the ages of 19 and 64 to complete 80 hours per month of "community engagement" to keep their coverage. That includes getting a job, going to school, taking a job training course, or community service. It's a big change for Kentucky, a state that just four years ago embraced former President Obama's health care law under a previous Democratic governor who won praise for posting some of the largest insurance coverage gains in the country.
But GOP Gov. Matt Bevin said while more Kentuckians have insurance, it is not making them healthier. Kentucky, along with the rest of Appalachia, still falls behind the rest of the country in 33 out of 41 population health indicators, according to a recent study. Bevin believes his program will encourage people to be healthier. In its application to Washington, Bevin's office said it expected the changes to save taxpayers more than $300 million over the next five years. They said the new rules will apply to about 350,000 Kentuckians, about half of whom already have jobs. They estimated as many as 95,000 people could lose their Medicaid benefits, either because they did not comply with the new rules or they lose their eligibility when they get jobs that pay too much money. The AP has more on the exemptions from the requirements and the pushback against them.