Bevin celebrated federal approval Friday, calling it "a significant milestone on our journey to lead the nation in transforming Medicaid in a fiscally responsible way". And it's not about promoting financial independence - we have yet to see a plan for creating better paying jobs that offer benefits.
Administration officials call that "community engagement" a key component of the program they've named Kentucky HEALTH.
"It will be a model for the nation", he said.
However, Bevin has said he would support for the state's Medicaid expansion with limitations, such as a work requirement.
Pugel previously had told Insider that many people who will lose coverage have chronic illnesses that will go untreated until the severity of their conditions brings them to local emergency rooms, where they will receive expensive care that will be paid either by the hospitals through charity care - or by people with insurance who pay higher rates than they normally would.
Bevin agreed the plan might face a legal challenge but seemed unconcerned.
While the Trump administration signaled willingness this week to allow work requirements for Medicaid beneficiaries, the Florida Legislature is unlikely to move ahead with such a mandate this year.
Yesterday the Trump Administration released proposed guidelines for those states that wish to impose work requirements on Medicaid recipients.
Bevin has said that the system can not continue as it has because it costs too much, ignores private market dynamics and fails to prepare Kentuckians for self-sufficiency.
"When many doctors refuse to accept Medicaid patients or place restrictions on patient access to care, it becomes harder for parents to find quality physicians for their children within a reasonable geographic area", said senior study author Dr. Andrew Racine, a researcher at Albert Einstein College of Medicine and Montefiore Health System in Bronx, New York.
Besides work requirements, the waiver also makes several other changes to Kentucky's Medicaid program.
Dustin Pugel, policy analyst with the Kentucky Center for Economic Policy, said Friday the change will reverse "the historic progress" Kentucky made in health care over the past two years.
Kaiser Health News (KHN) is a national health policy news service. "It's not about employment encouragement".
Kentucky says able-bodied adults need to prove they've done at least 80 hours of work a month to get their benefits. The image of a wholesale work requirement in Medicaid is misleading.
About 480,000 Kentuckians were added to Medicaid after the program was expanded under the Affordable Care Act, also known as Obamacare, to include anyone up to 138% of the federal poverty level, an annual income of $16,643 for an individual.
In a speech to state Medicaid officials in November, Verma indicated that the Trump administration would be receptive to adding work requirements and considering other conservative policy ideas to reshape Medicaid.
Failure to pay a premium after a 60-day grace period would result in them losing coverage and being unable to enroll again for six months unless all past due and current premiums and the beneficiary completes a "state-approved health literacy or financial literacy course".
The Maine Department of Health and Human Services previous year sought federal Medicaid officials' permission to require non-disabled, low-income adults enrolled in Medicaid to work as a condition of receiving coverage. "These radical and counterproductive changes will result in almost 100,000 Kentuckians losing coverage".
Second, it is not really a work requirement.
"Productive work and community engagement may improve health outcomes", Brian Neale, the director of the federal Medicaid office, said Thursday in a letter to state Medicaid directors.
"They're going to try to force a square peg into a round hole", he said.
States are still awaiting formal approval of their requests.