Kentucky is the first state to force some Medicaid recipients to work or get job training. The state’s Republican governor says the new changes will bring “dignity” to recipients and, therefore, better health outcomes.

Changes to the state’s Medicaid program, a federal healthcare system which provides coverage to low-income citizens, were announced Friday. The announcement comes only one day after the Centers for Medicare and Medicaid Services set forth new policy guidance, allowing individual states to propose and design test programs like the one approved in Kentucky.

Starting in July, certain people in the state between the ages of 19 and 64 must complete 80 hours per month of “community engagement” requirements, in order to keep their Medicaid benefits. The activities include jobs training, community service or education.

Most recipients of Medicaid in Kentucky will also pay a premium based on their income. Some who miss a payment or fail to re-enroll in the program will be locked out of health coverage for six months.

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Certain groups will be exempt from the new changes, including former foster care youth, primary caregivers of a dependent, pregnant women, full-time students and the medically frail.

President Donald Trump’s administration has said states must set forth “reasonable modifications” for people battling opioid addiction and other such substance-use disorders, according to Reuters.

Kentucky Governor Matt Bevin (R) explained his support for the state’s new Medicaid policy during a phone interview with Fox News on Friday.

“The dignity that people get and receive from the opportunity to do for themselves, to be engaged in their own health outcome, is what ultimately leads to better health outcomes,” he said.

“Kentucky will now lead on this issue,” Bevin said during a news conference on Friday.

The Southern Poverty Law Center, a liberal advocacy group, said it planned to file a legal challenge against the changes, Reuters reports.

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At least nine additional states, which are predominantly led by Republican governors, have also proposed similar changes to the federal health care program in their own states. The states are Arizona, Indiana, Kansas, Maine, New Hampshire, North Carolina, Utah and Wisconsin.

RT

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