The federal government on Friday granted the first U.S. state, Kentucky, approval to implement work requirements for Medicaid beneficiaries.

Under the new requirements, eligible adults will be required to work 80 hours in order to qualify for benefits. Job training, education or community service would also count as work, according to the waiver submitted by the state in 2016. Certain applicants will also be required to pay a premium based on income.

Throughout the entire half-century history of Medicaid, designed to provide health care to low-income individuals, benefits have never been contingent upon applicants working. But nine other states are currently seeking approval to implement similar requirements.

On Thursday, the Trump administration issued guidance to states that they would be able to “incentivize” non-elderly, non-pregnant adult beneficiaries to work.

“[The Centers for Medicare & Medicaid Services (CMS)] will support state efforts to test incentives that make participation in work or other community engagement a requirement for continued Medicaid eligibility or coverage for certain adult Medicaid beneficiaries in demonstration projects authorized under section 1115 of the Social Security Act,” the government wrote in a letter to state Medicaid directors.

The idea is by no means a new one for the White House. While revealing the administration’s 2018 budget blueprint in May 2017, Office of Management and Budget (OMB) director Mick Mulvaney said that the administration’s goal was to ultimately ween Americans off of welfare programs and put them back to work.

“We’re no longer going to measure compassion by the amount of money we spend, but by the number of people we help,” Mulvaney said at the time. “If you’re in this country and you want to work … we’re going to get 3% growth and we’re going to give you the opportunity to work.”

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