WASHINGTON (Reuters) – Kentucky on Friday became the first U.S. state to require that Medicaid recipients work or get jobs training, after gaining federal approval for the fundamental change to the 50-year-old health insurance program for the poor.

The approval came one day after the Centers for Medicare and Medicaid Services issued policy guidance allowing states to design and propose test programs with such unprecedented requirements.

Kentucky’s waiver, submitted for federal approval in 2016, requires able-bodied adult recipients to participate in at least 80 hours per month of “employment activities,”

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