The Trump administration has approved Arizona’s request to impose work requirements on Medicaid beneficiaries.

Arizona is the eighth state to receive permission to impose work requirements on Medicaid beneficiaries, but will be the first to allow an exemption for members of federally recognized tribes.

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The Centers for Medicare and Medicaid Services said the tribal exemption “is consistent with the unique status of tribal governments.”

The work requirements can take effect beginning Jan. 1, 2020, and will impact about 120,000 people.

Under the rules, beneficiaries ages 19 through 49 will have to engage in “qualifying community engagement activities” for at least 80 hours per month, and report monthly that they are meeting the community engagement requirements.

The approval suggests that Trump administration health officials are determined to push ahead on a key priority for conservatives, despite criticism from Democrats and experts who warn of people losing coverage as a result of work requirements.

“Employment and community engagement are proven to have a positive effect on overall health and well-being. By aligning educational and employment incentives, and providing robust job search support services and educational opportunities, Arizona can create pathways toward better health outcomes and employment opportunities for our citizens,” Arizona Gov. Doug Ducey (R) said in a statement.

Pregnant women, beneficiaries who are medically frail and beneficiaries who are in active treatment with respect to a substance use disorder will be among those exempt from the requirement.

Arizona will provide a three-month grace period for individuals to meet the community engagement requirements once determined otherwise eligible.

If a beneficiary does not fully comply with the work requirements, including failure to report compliance for any month after the three-month grace period, that person will lose coverage for two months.

The administration did not approve Arizona’s request to implement a five-year maximum lifetime limit for beneficiaries who fail to comply with the work requirements.

Beneficiaries can regain coverage after the end of the two-month suspension as long as they continue to meet all other eligibility criteria.

Republicans say work requirements are a pathway out of poverty and provide an incentive for people to work. The administration said Arizona's two-month suspension "is expected to incentivize beneficiaries to participate in community engagement activities and take greater responsibility for their health and well-being."

But Medicaid advocates say work requirements are merely kicking people off Medicaid to save states money. They point to massive coverage losses in Arkansas, which was the first state to implement work requirements last year.

According to state data, more than 18,000 people have lost coverage since the policy took effect in August.