Alex Azar, secretary of the Department of Health and Human Services, appear during his swearing-in ceremony Monday at the White House. On Friday, he appeared in Indianapolis, where he praised the state's plan to require some Medicaid recipients to work. Photo by Chris Kleponis/UPI | License Photo

Feb. 3 (UPI) -- Indiana received federal approval to require some low-income residents to work, study or perform public service to qualify for Medicaid.

On Friday, the Department of Health and Human Services' Centers for Medicare and Medicaid Services approved the "Healthy Indiana Plan." Three weeks ago, Kentucky became the first state to be approved to install a work requirement. Other states are interested in similar plans.


Three years ago, the Obama administration rejected the state's attempt to impose work requirements.

Last summer, the state submitted a new plan, known as the Healthy Indiana Plan 2.0. That plan would require some 130,000 state residents on Medicaid who aren't already in compliance to work, enroll in school, undergo job training or volunteer for at least 20 hours a week over eight months each year.

Some of those residents, though, may be exempt from the requirements. Those exempt include people who are pregnant, some caregivers, the frail, students, people at least 60 years old and those being treated for substance abuse problems.

HHS Secretary Azar Azar, a former top executive at the Indianapolis-based pharmaceutical company Eli Lilly, appeared Friday in Indianapolis at a public hospital where nearly half the patients are on Medicaid and almost one in five is uninsured. He said the change "recognizes that Medicaid can be a pathway out of poverty."

"Today's announcement is one significant step in a long legacy of innovation in person-centered health care," said Azar, who was sworn in Monday, said at the event. "Indiana's vision and ours goes beyond the provision of quality health care. It recognizes that Medicaid can become a pathway out of poverty."

Indiana Gov. Eric Holcomb, a Republican, called his state's plan "the gold standard for the nation."

Center for Medicare and Medicaid Services Administrator Seema Verma previously was an Indiana-based healthcare consultant and the main architect of Indiana's first attempt at the plan while Vice President Mike Pence was the state's governor. Verma, who was not at the ceremony, recused herself from considering Indiana's application.

Indiana's plan will begin in 2019 and will last for three years. The state also will become the first to impose higher Medicaid premiums on smokers in the plan approved by the federal government.

Congressional Democrats and ACA proponents denounced the work requirement plan.

"In his first major act since joining the administration, Secretary Azar has given Indiana the greenlight to discriminate against low-income Americans who are just trying to stay healthy and get ahead," Sen. Ron Wyden, D-Ore., said in a statement. "Policies that lock people out of the health-care system for months at a time or place onerous barriers in the way of coverage do not make Medicaid better at providing health care."

Adam Mueller, advocacy director for Indiana Legal Services, told the Indianapolis Star employed people generally are healthier than those who are not, but it's not clear that working leads to better health.

"It's like saying being in the NBA makes you a taller person," he said.