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The Trump administration announced last week that it would allow states to impose work or other “community engagement” requirements for Medicaid beneficiaries—a first in the program’s history.

Though the administration says the policy will not apply to Medicaid beneficiaries who are pregnant, disabled, elderly, or deemed “medically frail,” millions of adults could now face work requirements—and potentially risk losing their insurance. A report from the Kaiser Family Foundation estimates there are nearly 25 million adults on Medicaid, 60 percent of whom are already working. But as my colleague Noah Lanard explains, many Medicaid beneficiaries who don’t work face obstacles entering the workforce.

More than a third of those 25 million Americans say they are ill or disabled, and 30 percent say they’re taking care of “home or family.” Two-thirds of Medicaid recipients in Michigan who are “out of work” say they have a chronic illness.

Under the new policy, states must first apply and receive a waiver from the Centers for Medicare and Medicaid Services. Kentucky received an approval last Friday, and nine other states—Arizona, Arkansas, Indiana, Kansas, Maine, New Hampshire, North Carolina, Utah, and Wisconsin—have applications pending. And more could apply.

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