The latest decision will likely be seen as a major setback for the Trump administration, which has long worked to curtail benefits by mandating low-income people participate in some sort of work or community engagement in order to be eligible for health coverage. In early 2018, the Trump administration authorized the first major changes to Medicaid, a 50-year-old entitlement program that has long functioned as a safety net for those close to and below the poverty level. The program changes took effect in Arkansas in June 2018, at which point Medicaid recipients were required to work, search or train for work, or volunteer for a total of 80 hours a month. In December, Vox reported that the Medicaid work requirement in Arkansas had caused roughly 17,000 people to lose their coverage after three months of noncompliance with the new rules.

This latest ruling is not the first of its kind from U.S. District Court Judge James Boasberg, who has previously ruled against “engagement” requirements that mandate Medicaid recipients perform some sort of labor in exchange for federally subsidized healthcare coverage. The U.S. Department of Health and Human Services had previously given Arkansas and Kentucky the go-ahead to require low-income individuals to meet work requirements in order to receive assistance.

At least 15 states have proposed changes to Medicaid programs since 2017, according to reporting and analysis by The Pew Charitable Trusts.