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The Centers for Medicare & Medicaid Services Friday a Section 1115 demonstration waiver for Indiana that will require some adult beneficiaries to work or participate in other “community engagement” activities, such as job training or volunteer work, to remain eligible for coverage. The waiver extends the Healthy Indiana Plan through 2020 with other reforms, including a premium surcharge for beneficiaries who use tobacco and a new funding authority to expand treatment options for Medicaid enrollees struggling with opioid addiction or substance abuse. CMS last month issued policy guidance for states proposing demonstration projects that require or encourage working-aged Medicaid beneficiaries who are not pregnant or disabled to participate in work or other “community engagement” activities, subsequently approving the first such waiver for Kentucky. At least eight other states have submitted proposals that include community engagement initiatives: Arizona, Arkansas, Kansas, Maine, New Hampshire, North Carolina, Utah and Wisconsin.