For the second month in a row, over 4,000 Medicaid beneficiaries lost their health insurance after failing to meet work requirements for the program. The newest numbers, released Monday in a state report, come on the heels of a purge of 4,353 individuals in September, bringing the total number of people who have lost coverage to 8,462 in Arkansas.

In June, Arkansas became the first state in the country to implement a work requirement for Medicaid recipients. The program, which requires non-exempt workers to log 80 hours of work or work-related activities a month in order to maintain coverage, quickly came under fire by health care advocates. In August, three advocacy groups, two of which were also involved in a lawsuit that got similar requirements thrown out in Kentucky, sued on behalf of three Arkansas Medicaid recipients in order to block the rule.

Arkansas is one of four states that received federal approval to implement work requirements—a policy that the federal government prohibited when Barack Obama was president, but has changed since Donald Trump took office. Eight other states have applied for work requirement waivers that are still pending before the Trump administration.