The Centers for Medicare and Medicaid Services has approved work requirement waivers for Maine and Michigan, increasing the number of states to have work requirement programs approved to seven.

Michigan's waiver would enforce a more severe penalty for noncompliance than has been approved for Arkansas, the only other state that has implemented a program. Arkansas' program has led to nearly 17,000 people losing Medicaid coverage.

CMS approved the waivers for Michigan and Maine on Dec. 21. Michigan's program will require people to work or participate in community engagement activities like school or volunteering for at least 80 hours per month. If someone does not comply with the requirements for three total months in a year, they are kicked out of the state's Medicaid program for at least one calendar year.

While this is more severe than Arkansas' penalty, unlike Arkansas, people in Michigan can apply to be re-enrolled in the program. If re-enrolled, the Medicaid recipient has to meet the work requirement every month after.

Maine's program requires people to work or participate in community engagement activities for 80 hours a month as well. However, Maine will remove someone after three months of noncompliance in a 36-month time frame, not a calendar year. Maine's program also allows people to re-apply to the program.

Maine's program was approved shortly before Gov.-elect Janet Mills is set to take office. Mills, a Democrat who has promised to enact the state's long-delayed Medicaid expansion plan, had not released a statement regarding the approval as of publication.

Like other work-requirement waivers, Maine and Michigan's programs will exempt full-time students, pregnant women, a caretaker of a family member under the age of six, and any person with a disability under the Americans with Disability Act.

CMS Administrator Seema Verma has continually defended work requirements despite criticism of the programs and ongoing legal challenges. A further nine states have waivers pending before the CMS, according to the nonpartisan Kaiser Family Foundation.