The Trump Administration is encouraging states to require “able-bodied” Medicaid recipients to work or volunteer in order to keep their health insurance coverage.

On Thursday, the Centers for Medicare and Medicaid Services issued new guidelines for states that want some adults to work in exchange for the health insurance coverage.

Under the rules, states can require Medicaid beneficiaries to work, volunteer or participate in job training. People who are elderly or disabled, and pregnant women and children, would be excluded.

CMS Administrator Seema Verma said on Twitter that the new efforts will “improve Medicaid enrollee health outcomes by incentivizing community engagement.”

Ten states — Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin — have already filed applications with CMS to add work requirements to their Medicaid programs.

But it’s not clear how many people would be affected by the new rules. A study in December in JAMA Internal Medicine found that about half of the Medicaid recipients in Michigan were already working.

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