The Trump administration has approved a proposal from Kentucky that would require some Medicaid beneficiaries to work, volunteer or take classes as a condition of being enrolled in the program.

The commonwealth will become the first state in the country to implement such requirements, a request it initially made under the Obama administration. Under former President Barack Obama, the government determined that work obligations ran counter to Medicaid’s mission of providing medical assistance to low-income people. Centers for Medicare and Medicaid Services Administrator Seema Verma helped to write the waiver as a private contractor, prior to the presidential election and to taking on her role in the administration, and recused herself from its review.