Indiana has become the second state to require some Medicaid enrollees to work if they want to keep their coverage, extending President Trump’s push to revamp taxpayer-funded insurance without help from Congress.

Health and Human Services Secretary Alex Azar — in one of his first major acts since being sworn — announced the changes in renewing Healthy Indiana, a state program that put a conservative spin on President Obama’s vast expansion of Medicaid coverage to able-bodied adults.

Kentucky last month became the first state to require Medicaid benefits to work, part of a historic shift in how Washington oversees Medicaid — an outgrowth of the Great Society ushered in by President Lyndon B. Johnson a half-century ago.

Mr. Obama frowned on work requirements, but the Trump administration took the opposite view and encouraged states to condition benefits on pursuing a job or other forms of community engagement, such as volunteering or attending school.

Democrats are furious, saying the changes and its reporting requirements will knock people out of coverage, yet Mr. Azar said Medicaid should be viewed as a useful step toward getting out of poverty, and that people deserve the “sense of purpose often obtained through work.”

Mr. Azar said 11 other states are interested in establishing work requirements.

Indiana will require nonexempt Medicaid enrollees to work or engage in some form of community engagement for 20 hours per week for eight months out of the year. Certain groups, such as pregnant women, students and the medically frail, are exempt from the requirements, leaving about 130,000 out of 440,000 Healthy Indiana participants subject to the new rules.

“This is actually a limited piece of the Medicaid program, but it is a huge population all by itself,” Mr. Azar said.

Seema Verma, administrator of the Centers for Medicare and Medicaid Services, did not attend the announcement because she’s recused herself from Indiana’s waiver process.

As a private consultant, she helped Vice President Mike Pence — who was Indiana governor at the time — design the underlying Healthy Indiana program in 2015.

Neighboring Kentucky will begin to phase in its work requirements this summer. The plan requires many adults on Medicaid to perform 80 hours of community engagement per month and pay income-based premiums of $1 to $15.

Democrats and allied groups say the push is part of Mr. Trump’s attempt to “sabotage” Mr. Obama’s efforts to make government-funded health insurance more accessible.

They say Medicaid recipients who do not work would like to, but they’re trying to get healthy first.

“In his first major act since joining the administration, Secretary Azar has given Indiana the green light to discriminate against low-income Americans who are just trying to stay healthy and get ahead,” said Sen. Ron Wyden, Oregon Democrat. “Policies that lock people out of the health care system for months at a time or place onerous barriers in the way of coverage do not make Medicaid better at providing health care. It just makes families’ lives more difficult — period.”

Fifteen Medicaid enrollees in Kentucky filed a class-action lawsuit against the Trump administration last month, alleging the waiver flouts the objectives of Medicaid law.

Eliot Fishman, senior director at Families USA — an advocacy group for health care consumers — argued Indiana’s approval will strengthen the lawsuit.

“Part of the legal challenge is that an executive branch demonstration authority should not be used to make extra-statutory changes to the Medicaid program,” he said. “If multiple states are all pursuing these waivers, at some point it’s no longer a demonstration, it is just a change to Medicaid law without going through Congress.”

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