WASHINGTON — The Trump administration has issued guidance that opens the door to work requirements for Medicaid recipients, a major change in the 50-year-old program offering a safety net for Americans living in or near ­poverty.

The White House touted the move for Medicaid work requirements as “making a positive and lasting difference” in the health and wellness of Americans as they move into jobs that provide health insurance.

Requiring work for benefits is a GOP policy staple, but until last month no state had ever been able to get federal approval to impose work requirements on Medicaid beneficiaries.

Last month Kentucky received a waiver from the Centers for Medicare & Medicaid Services (CMS) allowing it to add work requirements for Medicaid beneficiaries, and several other states are working to impose similar eligibility requirements.

The majority of the nation’s 74 million Medicaid beneficiaries are already working at wages that put them below or just above the poverty line.

In Kentucky, most Medicaid beneficiaries who are 19 to 64 and are not disabled must work at least 20 hours a week, beginning in July. Beneficiaries could also satisfy the requirement through volunteer work, job training, taking classes, caring for an elderly or disabled person, or looking for a job.

Exempt from the Medicaid work requirements would be pregnant women, full-time students, primary caretakers of dependents and the chronically ­homeless.