Arkansas Gov. Asa Hutchinson speaks at a news conference about a ruling against the state's work requirement for its Medicaid expansion program at the state Capitol in Little Rock, Ark., Thursday, March 28, 2019. (AP Photo/Andrew DeMillo)

LITTLE ROCK, Ark. - An effort to keep Arkansas' Medicaid expansion failed Friday in the state House, leaving the future of coverage uncertain for thousands of low-income residents two days after a judge blocked the state's work requirement on the program.

The majority-Republican House voted 52-28 in favour of the budget bill for Medicaid and the expansion program, nearly two dozen votes shy of the 75 needed in the 100-member chamber to send the legislation to GOP Gov. Asa Hutchinson.

The vote came after a federal judge on Wednesday blocked Medicaid work requirements in Arkansas and Kentucky. Hutchinson on Thursday urged the federal government to appeal the ruling and said he wants lawmakers to maintain the expansion, which covers about 235,000 low-income residents. Several lawmakers, however, said they need answers about how the ruling affects the program and its budget.

"We are being asked to vote on a more than $8 billion Medicaid budget less than 48 hours after a court decision that has a pretty significant effect on the Medicaid budget, and I cannot support that," Republican Rep. Grant Hodges, who voted against the measure, said on the House floor.

Republican House Speaker Matthew Shepherd said the chamber would likely vote again on the measure early next week, and he and the governor both expressed optimism it eventually would pass.

"Some House members still have questions regarding Wednesday's work requirement ruling. That's to be expected," Hutchinson said in a statement released by his office. "I expect a second vote next week, and I trust the bill will pass."

The Senate approved the bill on Wednesday shortly before the ruling against the work requirements came down. Arkansas' expansion, which uses federal and state funds to purchase private insurance for low-income residents, has sharply divided the majority-Republican Legislature since it was created in 2013 and has prompted budget standoffs in recent years. Hutchinson inherited the program from his Democratic predecessor and supported keeping the expanded coverage, but with additional restrictions such as the work requirement.

Arkansas was the first state to enforce the requirement after the Trump administration allowed states to tie Medicaid coverage to work. More than 18,000 people lost coverage last year because of Arkansas' requirement. Those kicked off the rolls were able to re-enrol beginning in January, and Hutchinson has said about 2,000 of them had done so.

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News from © The Associated Press, 2019