The Trump administration is offering states a path to impose new work requirements for some people who get health insurance under Medicaid, the program that serves 68 million primarily low-income, elderly and disabled Americans. This is a historic shift. Never in Medicaid’s 52 years have people had to work in order to get health insurance. Federal health officials Thursday morning said 10 states have requested work requirement waivers that would force healthy, working-age adults to have a job, volunteer or be in school. States say the goal is to help people move into steady work — and by shrinking the program, to save money.

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