Seema Verma, the head of the Centers for Medicare and Medicaid Services, signs paperwork at the state Capitol in Little Rock, Ark., on Monday, March 5, 2018, that gives the state permission to require that thousands of people on its Medicaid expansion seek ways to work or volunteer. Traditional Medicaid recipients are not affected. Arkansas is the third state to win permission, following Kentucky and Indiana. (AP Photo/Kelly P. Kissel)