"This new guidance paves the way for states to demonstrate how their ideas will improve the health of Medicaidbeneficiaries, as well as potentially improve their economic well-being", said Brian Neale, director for the Center for Medicaid and CHIP Services at CMS.
But advocates said work requirements will become one more hoop for low-income people to jump through, and many could be denied needed coverage because of technicalities and challenging new paperwork.
The work requirements will likely have an impact on a broad number of adults.
"One of the things that states have told us time and time again is that they want more flexibility to engage their working-age, able-bodied citizens on Medicaid", Verma told a conference of state Medicaid directors in November.
Pregnant women, children, the elderly and those in drug treatment would be excused.
Many Medicaid recipients are employed.
Arizonans who don't qualify for an exemption would have to work, be actively looking for work, or be in school or job training for at least 20 hours per week. The office plans to take a close look at how their waiver can align with the new federal guidelines. They are among the states awaiting word from CMS on their requests to impose work requirements - efforts that were routinely rejected under the Obama administration when states broached them before.
Kentucky also anticipates the most drastic drop in Medicaid enrollment out of the 10 states with pending work requirement waivers, according to an analysis by the Commonwealth Fund.
Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin already filed applications to add the work requirements, according to NPR. Demonstrations, which give states additional flexibility to design and improve their programs, are also created to evaluate state-specific policy approaches and better serve Medicaid populations.
Overall, the guidance is being offered "to strengthen the Medicaid program to better serve our beneficiaries", Verma said. This policy helps people achieve the American dream.. Medicaid plays a key role in the national response to the opioid epidemic, which the Trump administration has declared a public health emergency, for example.
The shift under Trump could draw legal challenges from health care, rights or seniors' groups.
And people in Medicaid are often dealing with crises - they may move a lot, or change phone numbers, making them hard to track down.
CMS plans to support the addition of "community engagement" incentives to state 1115 Medicaid waivers that contain work eligibility requirements for able-bodied adults, the agency announcedin a press release.
Advocacy groups said most Medicaid recipients already have jobs, and those who do not may have difficulty accessing transportation to get to and from work or need to care for family members. Almost 8 in 10 are part of families where at least one person works, and 60 percent are working themselves.
In its guidance, CMS pointed to studies that show working and volunteering can contribute to better health as justification that the requirement is in keeping with Medicaid's mission.
Thursday's administration guidance spells out safeguards that states should consider in seeking work requirements.
A large majority of Medicaid recipients, nearly two-thirds, are children, elderly or disabled, and will be exempt from the new requirements.
-Taking into account hardships for people in areas with high unemployment, or for people caring for children or elderly relatives. "And cutting off people from Medicaid is certainly not going to improve their health".
We believe that the work requirement is indeed a problem because it is not consistent with Medicaids objectives to furnish medical assistance, she said.
"I'm not trying to put the guy that's bedridden in a factory somewhere", said Rep. Dan Moul, (R) - Adams County.
Trump's new direction can be reversed by a future administration.
Verma and other conservatives argue that forcing working-age Medicaid beneficiaries to work or seek work - a strategy used for years in other federally funded aid programs for the poor - will improve their health.