HELENA, Mont. (AP) — Republican lawmakers want Montana to require able-bodied adults to work or do volunteer work to qualify for health insurance under Medicaid expansion.

However, a report commissioned by the Montana Healthcare Foundation indicates only about 4 percent of able-bodied adult recipients aren’t working.

Senate Majority Leader Fred Thomas of Stevensville is one of 67 lawmakers who signed a letter to Gov. Steve Bullock asking him to apply for a federal waiver so Montana could enact a work requirement for continued Medicaid expansion coverage.

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“The program was never meant to be a forever entitlement, but rather a tool to get people physically and mentally healthy and in a better position financially to regain their independence from government welfare,” the Oct. 1 letter says.

More than 96,000 Montanans are enrolled in the expansion group, a number that Thomas said isn’t sustainable.

Montana’s Medicaid expansion law requires people to pay premiums and co-payments for their coverage, totaling a maximum of 5 percent of their income. That requirement is waived if people participate in voluntary workforce training and employment services programs.

A study shows 2 percent of Montana’s Medicaid expansion participants — or 2,500 people — have received intensive one-on-one workforce training or other services.

Thomas argues that training, volunteering or work should be required, with exceptions for people younger than 19, older than 64, pregnant or caring for a baby under the age of 1. People with serious medical conditions or disabilities and those participating in drug or alcohol treatment also would be exempt from the requirement.

The report commissioned by the Montana Healthcare Foundation found two-thirds of adults enrolled in Medicaid expansion were working. Nearly one-quarter were ill, disabled or a caretaker for someone. Six percent were in school and 4 percent reported being unable to find a job.

Bullock told Lee Newspapers of Montana the state should continue its voluntary program because a work requirement would cost more to administer.

“Montana has a national model that other states are looking to and that is actually putting people to work,” Bullock said.

The governor also noted an application for a Medicaid waiver would require legislative approval.

Three states have a work requirement and others are seeking waivers, according to the Kaiser Family Foundation.