Trump administration grants Wisconsin plan to make residents work for Medicaid

Wisconsin Gov. Scott Walker, a Republican who is battling to keep his job, hailed the move. Health care has become a central focus of the race, with Walker promising to protect those with pre-existing conditions even as he pushed for work requirements and supported a lawsuit that seeks to invalidate Obamacare.

"We're removing barriers to work to help Wisconsinites transition from government dependence to true independence!" he tweeted.

The move also comes as the administration is defending two other waiver approvals in court. A US District Court judge voided federal approval of work requirements in Kentucky in June, just days before the mandate was set to begin. And three consumer groups filed suit in August to halt the requirement that's already gone into effect in Arkansas, where more than 8,000 low-income residents lost their coverage in the first few months.

Administration officials, however, maintain that these approvals are rooted in compassion and help Americans achieve self-sufficiency -- a long-held conservative view when it comes to lifting people out of poverty. Seema Verma, the Centers for Medicare & Medicaid Services administrator, said that she recognizes that some people disagree with work requirements, but the agency feels that local policy makers should craft ways to help their communities.

"We will not retreat from this position," said Verma, noting that Wisconsin's unemployment rate has hovered around 3% for a year. "What this means is that there are real, life-changing opportunities available to help lift individuals out of the shadows of opportunity and into its light."

Indiana and New Hampshire have also received permission to impose work requirements, though those programs have yet to begin. At least seven other states are seeking the nod from the Centers for Medicare & Medicaid Services. Some have not expanded Medicaid at all, meaning only the poorest residents -- such as parents making less than $10,000 a year -- even qualify for coverage.

In Wisconsin, the new mandate covers 178,000 childless adults under age 50 with incomes below the poverty level. They will have to spend at least 20 hours a week working, going through job training, volunteering or participating in other qualifying activities to retain their health benefits. The disabled, medically frail and primary givers are exempt.

Recipients will have 48 months to come into compliance before they get locked out of the program and lose medical benefits for at least six months.

Also, these adults will have to complete a health risk assessment when they apply for Medicaid. The state will be allowed to vary premiums based on how they answer the assessment and whether they avoid behaviors that worsen their health, such as failing to exercise, maintain a healthy body weight or wear a seatbelt, as well as drinking excessively and using drugs or tobacco.

The administration, however, did not approve Wisconsin's request to test Medicaid beneficiaries for drug use.