The Centers for Medicare & Medicaid Services (CMS) [official website] on Thursday issued guidance [text, PDF; press release] that will allow states to require people to work as a condition to receiving Medicaid.

CMS reasoned that health care is but one determinant of health, and that “a broad range of social, economic, and behavioral factors can have a major impact on an individual’s health and wellness, and a growing body of evidence suggests that targeting certain health determinants, including productive work and community engagement, may improve health outcomes.”

Limiting the applicability of the guidance to “working-age, non-pregnant adult Medicaid beneficiaries who qualify for Medicaid on a basis other than a disability,” CMS outlined state-level programs it would support:

[CMS] encourages states to consider a range of activities that could satisfy work and community- engagement requirements. Career planning, job training, referral, and job support services offered should reflect each person’s employability and potential contributions to the labor market. As many Medicaid beneficiaries live in areas of high unemployment, or are engaged as caregivers for young children or elderly family members, states should consider a variety of activities to meet the requirements for work and community engagement, including volunteer and tribal employment programs, in addition to the activities identified to meet the requirements under SNAP or TANF.

So far ten states including – Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin – have applied for a federal waiver to include employment as a condition to Medicaid enrollment. These programs require the federal government to grant so-called Section 1115 [text] waivers, based on whether the “experimental, pilot, or demonstration project […] is likely to assist in promoting the objectives” of the Medicaid program more broadly.

CMS Administrator Seema Verma [official bio] spoke with the press on Thursdy, defending [The Hill report] the legality of the change, citing the administration’s “broad authority” under § 1115.