The Trump administration’s efforts to change the Medicaid program by allowing states to implement work requirements could be under threat as they are challenged in court and threatened by a new report that shows the steep cost of putting the changes into place.

Since the Trump administration announced states could apply to add Medicaid work requirements, nine states have received approvals for such programs. Some states, including Kentucky, have seen legal challenges to their programs, but more are considering applying to add similar programs to Medicaid. Kentucky's program has since been reinstated.

Currently, a panel of judges in the U.S. Court of Appeals for the District of Columbia is considering whether HHS was allowed to actually permit the program changes, Politico reported.

And the work requirements could come under further scrutiny after a Government Accountability Office report found the implementation costs are in the hundreds of millions, The Wall Street Journal reported. States did not have to provide cost estimates for implementing the work requirements when applying for approval. This is “inconsistent with federal control standards,” according to the WSJ.

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