Work or education is now required for many Michigan residents receiving Medicaid health coverage.
Gov. Rick Snyder signed the law Friday that affects able-bodied adults, ages 18 to 62. Starting in 2020, they'll have to show workforce engagement averaging 80 hours a month, such as a job, school, vocational training, an internship, substance abuse treatment or community service.
About 690,000 Michigan residents are covered by a 2014 expansion of Medicaid called Healthy Michigan. Supporters of the work requirement have said it is necessary to keep the program, which brings in adults with incomes at or below 133 percent of the federal poverty level, afloat.
"Our Healthy Michigan program has improved the lives of hundreds of thousands of Michiganders, and I'm very proud it has been so successful," Snyder said in a Friday press release. "I am committed to ensuring the program stays in place and that Michiganders continue to live healthier lives because of it."
The federal government must sign off on the Michigan changes still. If passed, more than 500,000 Healthy Michigan enrollees could be affected because they would not qualify for various exemptions, such as disability, being a full-time student, having a child under 6 or being pregnant.
Four states — Kentucky, Indiana, Arkansas and New Hampshire — already had their 20-hour-a-week work requirements approved by President Donald Trump's administration. Kentucky's is being challenged in an ongoing lawsuit. The federal government is considering work requirements proposed by seven other states, according to the National Academy for State Health Policy.
Michigan's requirement is widely panned by Democrats as cruel for depriving poor people of health care.
"Medicaid is not a jobs program. It is not a work program. It is a health care program," said Democratic Rep. Yousef Rabhi of Ann Arbor this month, adding that the insurance helps people struggling to find work or caring for family members.
The exact estimate of people who will lose coverage is unclear because most non-exempt enrollees already have a job. A legislative analysis found the plan would save the state $7 million to $22 million annually.
Michigan's expansion program would end if the Trump administration does not approve the waiver within a year of it being submitted. Several other GOP-led states have already tied work requirements to Medicaid eligibility.
When the Michigan bill passed the state Legislature on a party-line vote, sponsor Sen. Mike Shirkey said that a work requirement is the right step toward reinvigorating Michigan's economy.
"We have an obligation to review on a pretty regular basis all of our policies, all of our laws, all of our statutes that may unintentionally may result in disincentives to engage in the workplace," the Clarklake Republican said. "Right now, every business owner I know is seeking and searching for workers."