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The Centers for Medicare & Medicaid Services has promised to provide states flexibility to restrict eligibility, add wellness requirements, or increase recipient cost-sharing. Medicaid work requirements are the biggest change to happen to the program in some time. As of April 2019, seven states have had Medicaid work requirement waivers approved, six states have them pending, and Kentucky and Arkansas have had their work requirements blocked by the courts. States continue to expand their use of MCOs and are moving to encourage care coordination and integration of medical, pharmacy, and behavioral health services. MCOs, which administer care for 75 percent of those enrolled, continue to see Medicaid as a solid avenue for growth as commercial membership remains virtually flat.