Arkansas booted more than 4,300 residents from Medicaid coverage because they failed to report whether they complied with work and community engagement requirements the state implemented with President Trump’s blessing.

Several states have begun requiring able-bodied persons who receive taxpayer-funded insurance to find work, volunteer, or go to school, though Arkansas is the first to oust people in this way since Medicaid was established as part of the Great Society programs set up half a century ago.

Gov. Asa Hutchinson said nearly 44,000 Arkansans met the new requirements by working and reporting their activities or claiming an exemption from the requirements. He said those who were removed from the rolls had ample notice, citing more than 136,000 letters and emails, 150,000 phone calls and even door-to-door notifications.

“While many fully complied by taking advantage of work opportunities under the work requirement, there were some that either found work, moved onto other insurance, or moved out of state without notifying [state health officials],” the Republican governor said. “Some simply chose not to comply. Those are the ones who will lose their Arkansas Works coverage for the remainder of 2018.”

The Trump administration says states should be able to implement their Medicaid programs the way they see fit, and that conditioning benefits on work will push people off the government dole.

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Arkansas is the first state to enforce its new rules. Its decision to oust people will likely spark an outcry from advocates who fear many low-income enrollees will removed unfairly, because they don’t understand the rules.

Elsewhere, a federal judge put Kentucky’s Medicaid work requirement on hold in June, ruling the Trump administration cut too many corners in granting an Obamacare waiver.

Judge James E. Boasberg, an Obama appointee to the federal district court in Washington, D.C., ordered the federal Health Department to go back for a more thorough review of Kentucky’s proposal, saying it needed to take into account how any changes to states’ Medicaid systems would affect beneficiaries’ access to coverage.

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