Arkansas on Monday became the third U.S. state to require that Medicaid recipients work or participate in employment activities as a condition of receiving health insurance as the Trump administration continues to approve state requests that fundamentally change the 50-year-old program.

Arkansas’s waiver would require beneficiaries to work or participate in job training or job search activities for at least 80 hours per month as a condition of receiving Medicaid, the government health insurance program for the poor and disabled. Those who fail to meet the requirements for three months of a plan year will not be able to re-enroll until the following plan year.