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MADISON — President Donald Trump’s administration has approved Gov. Scott Walker’s controversial plan to require childless adults on Medicaid to work or lose coverage, but the federal government rejected Walker’s proposal to require drug screening and testing.

The state on Wednesday received permission to enact several changes to BadgerCare coverage for poor adults who don’t have dependent children, such as limiting eligibility to four years unless people work, train for a job or participate in certain other activities.

Wisconsin can now also charge monthly premiums of up to $8, along with $8 co-payments for emergency room visits for problems that aren’t considered emergencies. Members can reduce their premiums through “healthy behaviors,” such as not smoking or maintaining a healthy weight.

But Walker’s plan to require enrollees to be screened for drug abuse — and tested if screening called for it — was not approved. Instead, people will have to complete a health risk assessment, which will include questions about drug use. If the HRA indicates a concern about substance abuse, people will be referred for treatment but won’t have to comply to be eligible for Medicaid.

“In response to concerns identified by (the federal government) and commenters, Wisconsin revised its approach to include completion of the HRA as a condition of eligibility,” said a letter Wednesday from Seema Verma, administrator of the Centers for Medicare and Medicaid Services. “Responses to questions on the HRA will result in a referral for treatment, as applicable, but not impact an applicant’s Medicaid eligibility.”

The changes also include full coverage of residential treatment for substance abuse for anyone on Medicaid.

The work requirement applies to able-bodied childless adults ages 19 to 49. If they don’t work or engage in related activities for 48 months, they’ll lose coverage for six months, after which they can reapply.

Wisconsin is the fourth state to have a Medicaid work requirement approved, joining Indiana, Arkansas and New Hampshire.

Walker submitted his request for the changes in June 2017. The changes, many of them approved by the state Legislature in 2015, can’t start for another year.

Health care advocates have opposed the changes, saying they’ll make it more difficult for the poorest residents to maintain health coverage that could help them stay healthy and employable.

Mike Bare, research and program coordinator for the Community Advocates Public Policy Institute in Milwaukee, called the timing of the approval, less than a week before Tuesday’s election in which Walker is seeking a third term, “brazen.”

“Scott Walker and Donald Trump are putting barriers between low-income Wisconsinites and life-saving health care to score political points,” Bare said.

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Ken Taylor, executive director of Kids Forward, said the changes will increase the number of uninsured because many of the affected adults, whose incomes are below the poverty level, won’t be able to pay the premiums.

“We should be increasing access to health care not making it harder for people to get the care they need,” Taylor said.

Despite not getting all of his proposals approved, Walker believes the acceptance of most of them is a “huge step forward in helping people on government assistance move from dependence to true independence,” said his spokeswoman, Amy Hasenberg. “Wisconsin continues to lead the way on welfare reform,” she said.

In a statement, Walker said the changes will encourage more people to work.

“With more people working in Wisconsin than ever before, we can’t afford to have anyone on the sidelines: we need everyone in the game,” Walker said. “We want to remove barriers to work and make it easier to get a job, while making sure public assistance is available for those who truly need it.”

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