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To Get Medicaid in Kentucky, Many Will Have to Work. Advocates for the Poor Are Horrified.

Roughly 500,000 adults have joined Kentucky’s Medicaid rolls since the state expanded the program under the Affordable Care Act in 2014. Mr. Bevin has consistently attacked the expansion as a waste of money, questioning why “able-bodied” adults should be given free government health care that used to be largely limited to children, the elderly and the disabled.

He filed for federal permission to impose work requirements in 2016 — notably, instead of seeking to end the state’s Medicaid expansion altogether. And since then, more than a dozen other states have also sought work requirements or said they plan to. Several sought Medicaid work requirements during the Obama administration but were rebuffed.

The approval came just a day after the Trump administration gave states the O.K. to impose work or other “community engagement” requirements as a condition of getting Medicaid. According to the nonpartisan Kaiser Family Foundation, 60 percent of working-age Medicaid recipients who aren’t disabled already have full- or part-time jobs.

Under its plan, Kentucky will also require many adults who aren’t elderly or disabled to pay premiums of $1 to $15 a month, depending on their income. And it will disenroll people from Medicaid for up to six months if they fail to report changes in income or work status. Those who qualified for Medicaid under the Obamacare expansion will also have to “earn” dental and vision benefits, which they have been able to access freely until now, through activities like taking a financial literacy course or getting a GED.

The Bevin administration has estimated that the plan will result in 100,000 fewer Medicaid recipients after five years and save $2.4 billion, mostly in federal Medicaid funds. But Mr. Bevin couched the policy change as a moral rather than a fiscal decision, saying he did not care about the savings and saw it as an opportunity for Kentucky’s poor “not to be put into a dead-end entitlement trap but…

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