Indiana became the second state to implement work requirements for Medicaid on Friday after the Trump administration approved their waiver.

The Donald Trump administration approved a waiver for Indiana to implement work requirements for the Healthy Indiana Plan (HIP), which provides Indians health insurance. The waiver will also include a tobacco surcharge and up to $240 million over three years for addiction treatment.

Indiana now requires HIP recipients in “community engagement” activities, which includes going to school, participating in a job training program, working, or volunteering.

Alex Azar, the new Health and Human Services (HHS) secretary, said in a statement, “Today’s announcement is one significant step in a long legacy of innovation in person-centered health care. Indiana’s vision and ours goes beyond the provision of quality health care. It recognizes that Medicaid can become a pathway out of poverty.”

Kentucky became the first state to implement work requirements for their state Medicaid program in January.

Kentucky Gov. Matt Bevin said on Friday:

With federal approval of our Medicaid waiver, Kentucky will lead the nation in constructive changes to Medicaid. This marks the first significant change to a federal entitlement program in more than 20 years. The result will be a transformational improvement in the overall health of our people and will provide a model for other states to follow.

The Kentucky government suggested that with the Medicaid work requirements, they will save roughly $2 billion federal and state dollars over the next five years.

The Medicaid work requirements would only apply to able-bodied working-age adults. Americans with disabilities, older Americans, children, and pregnant women would not have to comply with potential Medicaid work stipulations.

A Rassmussen poll in January found that 64 percent of Americans approve of work requirements for Medicaid.

Indiana Governor Eric Holcomb said in a statement on Friday:

A decade after it launched, Indiana’s HIP program has become the national model for a state-led, consumer-driven healthcare program that meets citizens’ needs, provides choices and improves lives. … This approval continues coverage for hundreds of thousands of Hoosiers and unlocks funding to expand resources to help people struggling with addiction.

CMS administrator Seema Verma, who worked with then-Indiana Gov. Mike Pence to reform the state’s Medicaid program, said, “This gives us a pathway to start approving waivers. This is about helping those individuals rise out of poverty.”