The move marks a dramatic change to the 50-year-old program.

The Trump administration is paving the road for states to design new eligibility requirements for Medicaid, including forcing many recipients to work, look for work, or volunteer in order to qualify for government health coverage.

It’s a dramatic shift for the 50-year-old program. Under current law, eligibility for Medicaid is based almost entirely on income. But the Trump administration, after months of promises, is now telling states how they can introduce a new requirement that certain Medicaid recipients also work in order to receive health coverage through the program — a move that experts say is a significant departure from the program’s purpose of providing a safety net to Americans in or near poverty.

“Conditioning Medicaid eligibility and coverage on work is a fundamental change to the 50-plus-year history of the Medicaid program,” MaryBeth Musumeci, who studies Medicaid at the Kaiser Family Foundation, told me.

Right now, 10 states have proposals pending with the Trump administration to impose some kind of work or community engagement requirement, almost all of them led by Republican legislatures and governors. The Trump administration could move quickly to institute this kind of requirement in a substantial part of the country.

The new guidance from the Centers for Medicare and Medicaid Services offers some parameters for these requirements. Certain populations — the elderly and pregnant women, for example — are expected to be exempt. States are expected to consider various activities, including volunteering and caregiving, to comply with these work requirements. They are also asked to account for high unemployment in some areas and to accommodate, in the midst of the opioid crisis, people in drug treatment.

But in spite of the administration’s nods to these various vulnerable populations, critics said the guidance released Thursday did not actually provide Read More Here