Pregnant women, the elderly, individuals with disabilities or other health issues preventing work and, victims of domestic violence would be exempted from the new guidance, according to the letter from the Centers for Medicare & Medicaid Services (CMS).
Ten states, including ME and New Hampshire, had sent proposals to the federal government seeking the controversial change.
The Centers for Medicare and Medicaid Services announced new guidelines Thursday created to help state implement work and volunteer requirements for "able-bodied" Medicaid recipients. It is likely to draw strong political opposition from Democrats.
Health and Human Services Secretary Marylou Sudders said such a requirement has "not been something we've been pursuing" and indicated she likely won't seek to add it amid other efforts to reshape the state's Medicaid program, known as MassHealth.
It was expanded under President Barack Obama, with an option that has allowed states to cover millions more low-income adults; many have jobs that don't provide health insurance.
In addition, people who are disabled under the Americans with Disabilities Act but have Medicaid benefits for another reason could be exempted, or the state would be required to make "reasonable modifications" such as a reduced hourly requirement to ensure that the requirements don't disproportionately hurt people with disabilities.
Now 10 states have submitted 1115 demonstrations with work requirements which Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin. The agency is expected to start approving state waivers promoting "community engagement activities" in coming weeks.
Most of the population that would qualify for Medicaid expansion already works, Venable said.
Announcement of the new guidance delivers on the commitment made by Administrator Verma in her address to state Medicaid directors last November, to "turn the page" in the Medicaid program and give states more freedom to design innovative programs that achieve positive results for the people they serve and to remove bureaucratic barriers that block states from achieving this goal.
The elderly, disabled, children and pregnant women would be excluded from the requirements.
The federal-state collaboration has become the nation's largest health insurance program.
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The Obama administration would have never approved such waivers, she added.
According to the Kaiser Family Foundation, 40 percent of Medicaid recipients nationwide, or 9.8 million, do not work, while 42 percent work full time and 18 percent work part time.
Almost 20 percent of the population received Medicaid benefits in 2015, according to the United States census.
Lambeth said Carolina Cares would work "more like an insurance product for those working who can pay a portion of the cost, and the benefits and coverage are built around preventive and wellness care".
CMS said the new policy seeks to help improve the economic situation of Medicaid recipients.
The debate about work requirements doesn't break neatly along liberal-conservative lines.
Louisiana is developing a proposal to impose work requirements on certain adult Medicaid recipients, as the Trump administration announced it will allow states to enact such provisions.
States must also fully comply with federal disability and civil rights laws and ensure that all individuals with disabilities have the necessary protections to ensure that they are not inappropriately denied coverage.
A Kaiser survey in 2017 found that 70 percent of the public support allowing states to impose work requirements on Medicaid recipients.
Under the guidance, community engagement activities would include skills training, education, job search, volunteering or caregiving.