About 160 organizations are vocalizing their opposition to the administration’s recent decision to let states implement Medicaid work requirements, arguing the policy is “directly at odds” with the country’s efforts to fight the opioid crisis and improve re-entry from prisons.

Last month, the Department of Health and Human Services (HHS) issued guidance for states on designing work requirements in Medicaid, which marked a major conservative shift for the health insurance program for low-income and poor Americans.

The department has since greenlighted such measures in Kentucky and Indiana, allowing the states to impose a community engagement requirement — meaning certain Medicaid beneficiaries must be involved in such activities like work, volunteer, be enrolled in job training or school in order to obtain Medicaid coverage.

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Leading advocacy organizations in health care, civil rights, criminal justice and more sent a letter to HHS Secretary Alex Azar Thursday, writing that the provision harms vulnerable populations.

The Medicaid guidance says that states “states must make reasonable modifications” for those with an opioid addiction and must take measures to ensure they have access to Medicaid and treatment services.

But the groups wrote that they’re worried the provision will hurt those with an addiction.

“While [Center for Medicare and Medicaid Services] guidance directs states to take steps that enable people diagnosed with a [substance use disorder] to make Medicaid and treatment available, CMS fails to bind states to specific requirements for ensuring compliance,” groups — such as the American Psychological Association, National Alliance on Mental Illness and NAACP — wrote.

“For example, the CMS guidance suggests that states could elect to count time spent in certain types of SUD treatment toward work requirements; however, CMS does not require states to do so.”

The groups also raised concerns that the Medicaid work requirements fails to account for the difficulty those with a criminal record may have getting a job or finding volunteer opportunities.

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“The CMS guidance also fails to recognize the stigma, discrimination, and related legal and policy barriers to employment confronting people with criminal records,” the letter states.

The Trump administration has said that having a job improve people’s health, and helps people improve their health and wellbeing.

Three groups sued HHS over its approval of the Kentucky waiver, which was the first state to get the administration’s approval to impose a work requirement.