The Trump administration is preparing to approve a number of changes to Medicaid — the government health care program that provides coverage to low-income people — that could leave tens of thousands of people without coverage.

As Politico first reported Friday, the administration is set to approve waivers from some states that would impose work restrictions and allow questions about illegal drug use to be included on applications for Medicaid.

The report comes two days after numbers out of Arkansas showed more than 5,000 people could be in jeopardy of losing their Medicaid coverage after failing to meet the state’s work requirements.

According to Politico, the Trump administration is expected to sign off on work requirements in Arizona, Wisconsin, and Maine, and will reportedly allow Wisconsin to ask applicants about drug use, though the state would not be able to use the answers to make coverage decisions. One official told Politico that decision was a “political give” to Gov. Scott Walker (R), who has pushed for the ability to drug-test applicants.

Drug-testing applicants has never been done in any state, and Medicaid advocates say it would be illegal.

The Centers for Medicare and Medicaid Services (CMS) is also reportedly prepared to reject an attempt out of Arizona that would impose work requirements even on members of Native American tribes, a move that would challenge tribal sovereignty.

“The Trump administration seems intent on moving as quickly as possible to approve these harmful waivers which will clearly result in many more thousands of vulnerable people losing their Medicaid coverage,” Joan Alker, the head of Georgetown University’s Center for Children and Families, told Politico.


CMS declined to comment on Politico’s Friday report, but one Health and Human Services (HHS) official did tell the outlet that he believed there was “actually a clinical rationale for having community engagement.”

“I think it could be additive to health care,” the official, HHS Deputy Secretary Eric Hargan, said.

That rhetoric — that work requirements are not requirements at all, but rather opportunities — is favored by the Trump administration and its conservative allies, but not grounded in reality.

As Splinter noted Wednesday, a Kaiser Family Foundation analysis updated earlier this year tells a different story: Nearly eight in 10 people on Medicaid have at least one family member who works, and a majority of enrollees work themselves. Additionally, a majority of those who don’t work reported that they have “major impediments” to work, including a disability or caretaking responsibilities for family members.

Notably, Friday’s report that the administration is poised to allow conservative-led states to implement restrictive changes to Medicare comes less than three weeks after a study from the Koch-funded Mercatus Center found that implementing a single-payer Medicare for All health care system in the United States would reduce the amount the country spends on health care by more than $2 trillion over 10 years, as well as insure millions of people in need of coverage.