KELLY MCEVERS, HOST:

Yesterday the Trump administration opened the door to one of the biggest changes in the history of the Medicaid program. For the first time, the federal government will allow states to impose work requirements on people who get Medicaid. The first state, Kentucky, got the go-ahead today.

ARI SHAPIRO, HOST:

The idea is that able-bodied adults would have to show that they have a job, attend school, provide child care or participate in other community engagement activities. States would be able to define those terms.

MCEVERS: Critics say this requirement is illegal. They also argue that not having health coverage creates an obstacle to employment.

SHAPIRO: States that want this policy argue that community engagement makes people healthier. Gary Herbert is the Republican governor of Utah. I asked him what he wants to accomplish by having a Medicaid work requirement.

GARY HERBERT: What we hope to do is not only give people health care, which they need - and the reason they're coming to the federal government for health care is because they don't make much money. And so they qualify for Medicaid, for help from the government. And we want to not only give them the health care that they need through Medicaid, but also to help them with their economics. So we want to give them education, training, skills to help them get a job. And we believe that that's important, to not only, as the proverb goes, give them a fish and feed them for a day, but to teach them how to fish so they can feed themselves for a lifetime. We think that's good policy.

SHAPIRO: Most of the recipients of Medicaid are already working or doing child care or in school. Do you expect that this will dramatically change the rolls much?

HERBERT: I think it will significantly because I think it's an attitude change. It's a matter of saying, I'm going to come and ask for help, but I'm prepared to do my part to, in fact, get a job. And it's not just a matter of sitting in a classroom, twiddling my thumbs and biding my time. It's with, in fact, the goal in mind that I will get a job. That assumes that you're able-bodied, that you're capable physically and mentally to get a job. And because we have that kind of an attitude in Utah we, in fact, have a significant record of getting people off of the Medicaid rolls in around 10 months on average. But it would - we need to have government actually say we, in fact, are asking you to do - in a proactive way to get a better job. And we're going to help you do that.

SHAPIRO: But what I keep coming back to is if the data show that most people getting Medicaid are already meeting these requirements, is this a conceptual shift more than an actual shift in who is getting what kind of coverage?

HERBERT: Well, I think it's probably both, Ari. I don't think it's one at the exclusion of the other. Clearly, if we have an attitude of work, then that helps us get people so that they're not just comfortable being on the dole. You give government assistance and people's independence is eliminated. Their dignity is eliminated. They think, there's no way I can succeed. That's an attitude thing. So it's going to be not only attitudinal, but I think the actual results will improve us helping people get jobs. And Utah's a good example of that with our own welfare system here, some of it being done privately through churches and civic organizations. But we have a culture of work. And that's helped us, in fact, have better results with our Medicaid help than other states in America.

SHAPIRO: But that comes back around to the question of, if people are all new on the rolls for 10 months, if people are for the most part working already, then your description of people being on the dole and living off the government doesn't seem to match the reality of Medicaid in Utah.

HERBERT: Well, you can parse the data if you'd like, but the results of what we have tried to do by culture here can also be done by, in fact, rule and regulation and policy, which is the role of government. We're doing a pretty good job in Utah. I think we can do even more by coupling together, as we've done in other government programs. This is not a new concept of saying in exchange for this we ask you to do that.

SHAPIRO: I'd like to ask you about the opioid crisis and how this requirement could affect it. Utah has seen some of the highest rates of drug overdose deaths in the country. And a lot of people get treatment for addiction through Medicaid. Will your plan include drug treatment as an option to satisfy these requirements?

HERBERT: Absolutely. In fact, we are addressing that for all the states. It's not just Utah. I mean, this has come through the National Governors Association when I was the chair. It's a crisis level. But we clearly are going to be using monies that we have for our Medicaid expansion, for our health care, for our waivers, for additional monies. We have about a hundred million dollars that'll be coming into the state of Utah that's going to help us with, in fact, homelessness, with those who are addicted to opioids and other kinds of substance abuse, those that have mental health problems. So again, a role that government has to play to help us with improving society, and it's certainly at the top of the list here in Utah.

SHAPIRO: I know Republicans such as yourself often object to new regulations. Do you expect this to create a lot of paperwork either for Medicaid recipients or for the people implementing the policy?

HERBERT: I would hope not. Again, part of the essence of what we ought to be doing is, in fact, appreciate the states as laboratories of democracy. I'm much more in favor of giving a block grant or minimal amount of regulations and restrictions and let the states find their way. How we do it in Utah will not be the same they do it in California. The politics is different. The culture is different. The demographics are different. But let the respective states be their own little pilot programs. We'll learn from each other's successes. We'll learn from each other's failures.

SHAPIRO: Utah Governor Gary Herbert, thank you for joining us.

HERBERT: Thank you, Ari. Good luck to you. Transcript provided by NPR, Copyright NPR.