Republican-led states are stepping up their efforts with the Trump administration to pursue work requirements and other changes to Medicaid, in the face of legal challenges and Democratic opposition.

Tennessee Republicans want permission to revamp Medicaid in exchange for a fixed amount from the federal government. Utah is testing whether it can get approval for a partial Medicaid expansion with capped payments from the federal government. And Kentucky lawmakers have weighed drug-testing recipients with criminal or substance-abuse histories, among other steps.