States will now be free to impose work requirements on Medicaid enrollees, a policy shift intended to move Medicaid away from being an open-ended entitlement program that benefits able-bodied adults, according to Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma.

In a speech to state Medicaid directors, Verma said the Trump administration views Medicaid as a program that should help able-bodied adults “move on and move out.” Verma also announced that CMS will create the first-ever scorecards that will track state and federal Medicaid spending.

Critics say the administration aims to shrink the Medicaid program. According to the National Health Law Program, a legal health advocacy group for low-income and underserved groups, the new policies would “roll back significant progress” in expanding access to Medicaid. For example, Wisconsin has submitted a proposal to put a 4-year limit on benefits and charge premiums and copays to enrollees who earn between 50-100% of the federal poverty level. Other states are considering requiring drug testing, lifetime limits, and lockout periods when enrollees miss premium payments or commit other infractions.