Advocacy groups on Tuesday sued the Trump administration, arguing it acted outside the scope of its authority when it approved work requirements in Arkansas’ Medicaid program.

The National Health Law Program, Legal Aid of Arkansas and the Southern Poverty Law Center filed the suit in U.S. District Court in Washington, D.C., and claim the approval of Arkansas’ waiver is contrary to Medicaid’s objective of expanding access to health care for people with low incomes. 

Arkansas Republicans have long tried to implement work requirements on Medicaid recipients, but it was not until this year, under the Trump administration, that such efforts were approved. In 2016, the federal government approved a request by Arkansas officials to waive some Medicaid requirements as part of the states’ Medicaid expansion under the Affordable Care Act. As part of that request, Arkansas officials sought to impose a work requirement as a condition of Medicaid eligibility, but the Obama administration denied the request, finding work requirements inconsistent with the objectives of the Medicaid Act.

Advocates allege in the lawsuit that in early 2017 the Trump administration abruptly reversed course by signaling to states that it would revise its use of the waiver authority as part of President Trump’s vow to “explode” the ACA and its popular Medicaid expansion. Taking the administration’s cue, in late June 2017, Arkansas Gov. Asa Hutchinson (R) submitted to the Trump administration the “Arkansas Works Amendment,” a request to implement a work requirement as a condition of Medicaid eligibility. Hutchinson claimed the requirement was necessary to “promot[e] personal responsibility and work, encourag[e] movement up the economic ladder, and facilitat[e] transitions from Arkansas Works” to private coverage.

The request would require certain Medicaid recipients to work 80 hours a month or lose their benefits. If enrollees subject to the work requirement do not meet the requirement for any three months of the year, the state will terminate their Medicaid coverage unless the enrollee demonstrates they fit within one of the narrow “good cause” exceptions in the rule, the lawsuit states.

A person who has been terminated from Medicaid for failure to meet the work requirements could not re-enroll for the remainder of the calendar year.

The administration approved Arkansas officials’ request in March and the work requirement went into effect on June 1 for enrollees between the ages of 30 and 49 who are not disabled and don’t have dependent children at home. It will expand to those between the ages of 19 and 29 next year if not halted.

The lawsuit, filed on behalf of three Medicaid recipients in the state, seeks to block the requirement, arguing the requirements are contrary to both the Medicaid statute and the U.S. Constitution. Advocates argue neither Arkansas nor the Trump administration considered the harm work requirements have on Medicaid recipients when considering approval. It is the second lawsuit challenging states’ attempts to roll back Medicaid benefits. A federal court in June blocked similar requirements from taking effect in Kentucky. 

The Trump administration has approved requests to implement work requirements for Medicaid recipients in Indiana and New Hampshire. Those new rules have not yet taken effect in those states.