Attorneys representing 15 Kentuckians with low incomes filed a lawsuit Wednesday challenging the Trump administration’s efforts to allow states to impose work requirements on some Medicaid recipients. It’s the first of what advocates have promised would be many lawsuits challenging the administration’s Medicaid policy. 

The lawsuit, filed as a class action by the National Health Law Program (NHeLP), the Kentucky Equal Justice Center, (KEJC), and the Southern Poverty Law Center (SPLC), argues that the Department of Health and Human Services overstepped its authority in approving Kentucky Republicans’ proposed changes to its Medicaid program. Those changes, known as a waiver, would require Kentucky to require able-bodied adults without dependents to work or volunteer at least 20 hours a week to qualify for Medicaid coverage. 

Medicaid eligibility is based almost entirely on income. But the Trump administration this month released new guidance for state Medicaid programs that allows states to to add requirements for a person to keep Medicaid coverage. Almost immediately following the new guidance, GOP officials in Kentucky were granted by the Trump administration a request, pending since August 2016, to require some of its Medicaid recipients to work at least 20 hours per week or to participate in other “community engagement” activities like volunteering or actively looking for work.

Those who don’t meet the requirements would lose their Medicaid coverage. Medicaid covers around 75 million people, including 1.4 million people in Kentucky.

“These waiver approvals raise a host of legal issues—not just the work requirements and premiums but eliminating health care services, such as transportation to health care facilities or providers,” NHeLP Legal Director Jane Perkins said in a statement. “This amounts to a project demonstrating how to destroy a strong health care program.” 

“The Cabinet’s own estimate is that around 95,000 Kentuckians will lose Medicaid coverage,” KEJC Senior Attorney Anne Marie Regan said in a statement. “The purpose of Medicaid is to provide medical insurance to people who cannot afford it, not to create barriers to coverage. Demonstration waivers are supposed to make access to health care easier. This approval does the opposite. It is not only in violation of Medicaid law but is immoral.”

At least nine other Republican-led states are considering similar work requirements for Medicaid recipients.

The plaintiffs challenging the Kentucky waiver range in ages from 20 to 62 and include married couples, college students, a pastor, a mechanic, and a bank teller. Many of the plaintiffs with chronic health conditions like diabetes face real harm if they were to lose their insurance coverage under the plan, the lawsuit claims.

The Trump administration has not yet responded to the lawsuit.