Three groups are leading a lawsuit filed Wednesday against the Trump administration’s approval of major changes to Medicaid, including allowing work requirements.

The litigation challenges a waiver the Centers for Medicare and Medicaid Services (CMS) recently approved in Kentucky allowing the state to institute first-of-its-kind changes to the Medicaid program, arguing the measures are inconsistent with the purpose of the program.

Fifteen Kentuckians joined in the class action lawsuit filed in the U.S. District Court for the District of Columbia. Three major groups are representing them — the National Health Law Program (NHeLP), Kentucky Equal Justice Center and the Southern Poverty Law Center.

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“These waiver approvals raise a host of legal issues -- not just the work requirements and premiums but eliminating health care services, such as transportation to health care facilities or providers. This amounts to a project demonstrating how to destroy a strong health care program,” NHeLP Legal Director Jane Perkins said in a statement.

“Allowing the State to ignore fundamental Medicaid protections will result in large numbers of low-income individuals and families losing health care coverage. We are calling on the federal court to step in and stop the Trump administration from re-writing the Medicaid Act and stripping Kentuckians of vital health care.”

Top CMS official Seema Verma has argued the administration has “broad authority” under current law to let states alter their Medicaid programs through waivers. Earlier this month, the administration released guidance on work requirements in Medicaid, marking a major shift for the program. It subsequently approved a Kentucky Medicaid waiver requiring certain adults complete at least 80 hours per month of community engagement activities, such as work, education, job skills training or volunteering.

Those opposing Kentucky’s waiver will seek an injunction to block any provisions of the waiver from going into effect while the case winds its way through the court system, according to a summary of the lawsuit from NHeLP.

The lawsuit challenges various aspects of Kentucky’s waiver: work and premium requirements; a six month Medicaid coverage lockout if a beneficiary gets a new job or a different salary but doesn’t tell the state; and more.

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State officials have estimated Kentucky’s Medicaid waiver will result in 95,000 fewer people on Medicaid.

Federal law lets CMS approve state waivers that “promote the objectives” of the Medicaid program, which provides health coverage to low-income and disabled Americans. Democrats argue that the objective is to provide insurance, and that the new provisions will result in people losing their coverage. Ten other states have filed to begin implementing work requirements, but CMS hasn’t yet approved their Medicaid waivers.

Kentucky’s Republican Gov. Matt Bevin argues that state residents want the “dignity” of work, and has said that “able-bodied people” are essentially getting free care but not contributing to society.

A court battle over the Medicaid provisions had been telegraphed for months. Of potential litigation, Bevin said at a Jan. 12 press conference announcing the waiver’s approval that legal challenges were “conceivable. We live in America. There are lawsuits that fly around this town, this country. People certainly have that right.”

Bevin has since signed an executive order calling for the state to end its Medicaid expansion program if the waiver is found to be illegal. He has repeatedly said the program isn’t sustainable and that the waiver is a measure to bring down its costs.

Updated: 2:22 p.m.