PORTLAND, Maine — Medicaid recipients are pushing back against Maine’s proposal to create the nation’s toughest requirements for the health care program for low-income residents that states run.

The health care proposal recently approved by U.S. House Republicans would let states require certain Medicaid enrollees to work.

Republican Maine Gov. Paul LePage’s administration wants to require most “able-bodied” adults to work, volunteer or take classes if they receive MaineCare benefits. He also wants to require $20 co-pays for non-emergency emergency room visits and allow providers to charge for missed doctor’s appointments.

Maine says such adjustments may decrease enrollment and generate $8 million annually.

MaineCare recipient Judy Bullard said at a Wednesday hearing the program helps cover her expensive epilepsy medication. She said caseworkers can’t determine whether she can work by looking at her.