LANSING, Mich. (AP) — Michigan officials say more than 270,000 enrollees in the state’s Medicaid expansion program may have to meet work or related requirements to keep qualifying for their government insurance coverage.

The state Department of Health and Human Services began sending notification letters to those beneficiaries this past week. They comprise 42% of the 650,000 lower-income adults participating in the Healthy Michigan Plan.

Starting in January, abled-bodied adults ages 19 through 61 who want to maintain their benefit will, on a monthly basis, have to show workforce engagement averaging 80 hours a month — through work, school, job training or vocational training, an internship, substance abuse treatment or community service. The requirement was enacted by the Republican-led Legislature and then-Gov. Rick Snyder in 2018.

“We are doing everything in our power so that individuals can comply with this complex and demanding statute,” said Health and Human Services Director Robert Gordon. “Clear communication is key.”

The agency in October will also notify an estimated 380,000 Medicaid expansion recipients who are exempt, including those older than 61, pregnant women, people with disabilities, certain caretakers and others.

The letter going to the 270,000 enrollees includes a form to fill out if a beneficiary meets an exemption, so the number of people required to report monthly may drop. Participants will get more information in December on how to meet the reporting requirements.

Additional recipients may not be subject to reporting if pending legislation is enacted into law.

Bills approved by the Republican-led Senate and backed by Democratic Gov. Gretchen Whitmer’s administration would exempt people from reporting if the state can verify their compliance through other data. People would have a month to verify their compliance, instead of 10 days under existing law. There also would be a grace period for those who miss the deadline.

The House was scheduled to pass the measure Thursday but postponed the vote following questions that were raised by majority Republicans. A spokesman for House Speaker Lee Chatfield declined to elaborate, except to say legislators wanted to know more details and how the changes would be implemented.

Michigan is among nine states whose Medicaid work requirement waivers have been approved by the Trump administration. Indiana is the only state where they are in effect.

A federal judge has blocked Medicaid work requirements in Arkansas, Kentucky and New Hampshire, ruling that they undermine the Medicaid program’s mission of providing health care for the needy. Republicans have said the law — which most likely will face a court challenge, too — will help participants achieve self-sufficiency and fill job openings.

Gilda Jacobs, president and CEO of the Michigan League for Public Policy, which advocates for the poor and opposes the work rules, told lawmakers in June that the legislation is a small step in the right direction. But she said the tweaks likely would not address the main reason for coverage losses seen in Arkansas before its requirements were struck down: people not knowing they had to report hours or even how to report them.

“People’s very lives are at stake, and we must do everything we can in order to do the least amount of harm,” Jacobs said.