The Trump administration on Tuesday reapproved controversial Medicaid work requirements in Kentucky after the initial effort was blocked by a federal judge.

The move is a sign of the Trump administration’s determination to impose the conservative change on the health insurance program for the poor, despite criticism from Democrats who warn of people losing coverage.

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The judge’s ruling in June blocked the first attempt to approve the work requirements because it said the Trump administration failed to consider whether the plan would cause people to lose coverage and run counter to the objectives of Medicaid.

To get around that, the administration then opened a new comment period, which it said provided a new opportunity for added consideration of the proposal.

In a letter to Kentucky on Tuesday, the federal Centers for Medicare and Medicaid Services pushed back on concerns about people losing coverage if they don’t comply with the work requirements, saying the rules are intended to incentivize people to work, which it argued helps them lead better lives and promotes Medicaid’s objectives.

“The goal of these policies is to incentivize compliance, not reduce coverage,” CMS said.

Still, the agency acknowledged that the “vast majority” of the comments it received were from Kentucky citizens opposed to the new rules and concerned about “many poor citizens losing Medicaid.”

Secretary of Health and Human Services Alex Azar said in July that the administration was “undeterred” by the judge’s ruling and would continue approving Medicaid work requirements.

Requirements have been approved in five states so far, with several other states applying.

The rules have gone into effect in Arkansas, where more than 12,000 people have lost health coverage as a result, which opponents point to as a warning sign.