In January, Seema Verma, administrator of the Department of Health and Human Services' Centers for Medicare and Medicaid Services, decided that it would grant permission to states that wanted to created Medicaid work requirements. Kentucky quickly became the first to win approval. The move drew a swift lawsuit by opponents who contended that the change undermined the program's central purpose because even state figures predicted that perhaps 95,000 people would lose coverage within five years because they had not complied.