This story has been updated with additional comments and background.

Kentucky’s controversial overhaul of Medicaid has been approved by the federal government, the state Cabinet for Health and Family Services announced late Tuesday.

The state’s Section 1115 waiver, also known as Kentucky HEALTH, was initially approved by the Trump Administration in January but was sent back to the federal government for further review as a result of litigation.

The U.S. Centers for Medicare and Medicaid Services has now cleared the way for the program to begin as soon as April 1, according to a news release from the Cabinet.

A requirement that some able-bodied adults complete 80 hours a month of work or other “community engagement” will be rolled out regionally over several months beginning no sooner than April 1, according to the release.

“Kentucky HEALTH offers a customized path based on individual needs that will help beneficiaries gain better health, engagement in their communities, improved employability, and success through long-term independence,” the Cabinet’s secretary, Adam Meier, said in the release. “This individualized approach affords flexibility and procedural protections that will ensure Medicaid is able to provide beneficiaries access to services and opportunities, while utilizing a holistic approach to addressing barriers and challenges that affect overall health.”

The program, which was to kick off this past July 1, was stymied by a lawsuit filed on behalf of more than a dozen Medicaid recipients who alleged that the initial approval violated federal law and would jeopardize the health coverage of tens of thousands of Kentuckians.

U.S. District Judge James Boasberg vacated the approval and sent the proposal back to the U.S. Department of Health and Human Services for further review. CMS then opened up a comment period that drew more than 11,500 online responses that were largely against Kentucky HEALTH.

The consumer group Kentucky Voices for Health issued a statement Tuesday, lamenting the re-approval of the waiver.

Emily Beauregard

“Kentucky Voices for Health and our partners are deeply disappointed that CMS and, by extension, the state, have once again ignored the voices of their constituents,” the group’s executive director, Emily Beauregard, said in the statement. “During the 2018 federal comment period, thousands of Kentuckians spoke up to share why access to healthcare is critical to their ability to be good parents and caregivers, productive employees, successful entrepreneurs, and contributing members of their communities. Reapproving a waiver that makes hardworking Kentuckians jump through hoops to keep their coverage will no doubt have the opposite effect.”

Some other organizations, such as the Kentucky Center for Economic Policy, expressed similar concern.

“Re-approving these harmful barriers to quality coverage through Medicaid ignores the nearly 8,500 official comments that laid out the many ways people will be left behind,” said Dustin Pugel, policy analyst for the Kentucky Center for Economic Policy. “Kentucky’s historic gains in health coverage have led to real progress in our economic recovery and our health – especially in struggling rural areas – and CMS’s decision today turns the clock back on those gains.”

In the past, the state has indicated that 95,000 people would lose Medicaid coverage in the first five years of the program, Boasberg noted in his June 29 ruling, which took issue with the federal government initially having glossed over the potential impact of Kentucky HEALTH on individuals Medicaid was meant to protect.

The Foundation for a Healthy Kentucky, which has partnered with the state on the program, issued a statement Tuesday reaffirming its desire to help Kentuckians comply with requirements, such as premium payments.

Seema Verma | Courtesy CMS

“The Foundation remains committed to assisting Medicaid beneficiaries with their efforts to understand and comply with the waiver’s requirements,” the foundation’s chief executive, Ben Chandler, said in the statement. “It will take a collective effort by the state, providers, community organizations, and all those involved with the new Medicaid waiver to ensure Kentuckians are successful in meeting its requirements, so they do not lose health coverage.”

Kentucky is among a handful of states, including Indiana, Arkansas, Wisconsin and New Hampshire, that now have approval to require eligible “able-bodied” Medicaid recipients to work or do other community engagement activities, such as volunteering, to keep their benefits. Insider previously reported that Arkansas cut off thousands of residents’ Medicaid coverage after they failed for three consecutive months to report activities under the new requirement.

In a recent blog post, CMS administrator Seema Verma acknowledged that work requirements are controversial but stressed that the Trump administration would not back down.

“Some believe that our sole purpose is to finance public benefits, even if that means lost opportunity and a life tethered to government dependence,” she wrote. “Instead, what’s needed are local solutions crafted by policy makers who are closer to the people they serve and the unique challenges their communities face. We will not retreat from this position.”