The Trump administration is allowing Wisconsin to become the first state to compel certain poor residents to disclose behavior such as drinking and exercise to qualify for Medicaid – and to charge more to people whose behavior the state judges as risky.

Federal health officials, however, rebuffed an unprecedented effort by Wisconsin to impose drug tests on Medicaid applicants.

The rejection placed a limit on the flexibility the administration has been urging states to embrace for the vast safety-net health insurance system, though illicit drug use can be an item in a health-risks questionnaire.

The decisions were part of an announcement Wednesday that the Department of Health and Human Services’ Centers for Medicare and Medicaid Services has approved a plan that will make the Badger State the most recent with federal permission to compel people to work or prepare for jobs to receive Medicaid.

Four other states have won such permission this year, including Arkansas, which has cut off several thousand people from benefits for failing to meet its “community engagement” requirement.

A federal judge has blocked the work requirement in Kentucky, the first state to attain permission last winter; Wisconsin becomes the administration’s first new approval since the court ruling early this summer.

“I recognize that there are people who disagree with this approach,” CMS Administrator Seema Verma wrote Wednesday. “We will not retreat from this position,” she added.

Her agency’s decision in January to let states impose work requirements represented a profound shift in the public insurance program that began in the 1960s as part of the War on Poverty.

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