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Several thousand poor residents of Arkansas have been dropped from Medicaid because they failed to meet new requirements, the first Americans to lose the safety-net health insurance under rules compelling recipients to work or prepare for a job to keep their coverage.

Gov. Asa Hutchinson, announced Wednesday that 4,353 people have become ineligible for Medicaid, out of an initial group of nearly 26,000 who became subject to the requirements late this spring.

"I don't like that number," Hutchinson said of the residents who were removed. But noting that 1,000 people in the overall program have found employment, the governor called the requirement "a proper balance of those values that we hold important," including work and personal responsibility.

His state is the earliest proving ground for a polarizing idea, long advocated by conservatives but rebuffed by the federal government until this year, that Medicaid should follow welfare cash benefits and food stamps in requiring people to perform work or other kinds of "community engagement" to keep their benefits.

Under Arkansas Works, the state's expansion of Medicaid under the Affordable Care Act, able-bodied adults lose insurance if they fail to comply with the new rules for three months.

The requirements began in June for the initial group, who are ages 30 to 49. August was their third month, so the number announced Wednesday at an afternoon news conference represents the first beneficiaries to be dropped.

The concrete reality of more than 4,300 individuals losing insurance — diminishing their access to care — is alarming leaders at medical and mental health clinics and hospitals, as well as legal advocates for the poor. They say that logistics of the work rules are ill-suited to the lives of many poor Arkansans, who may not have computer access or may not have even received — or understood — letters the state sent telling them what they need to do to stay on Medicaid.

In Lee County in the Mississippi Delta, where poverty is rampant, nearly three-quarters of the people lack online access. "I've had people say, 'What's Arkansas Works?' and I'm thinking, oh my gosh, you don't even know what it is, so how do you know that you need to go online and report work," said Kellee Farris, who runs the Lee County Cooperative Clinic, which has provided health services to the poor since 1969.

Federal health-care officials have approved work requirements in three more states and have received proposals from 11 others, but Arkansas is the only place where the rules have taken effect.

After the administration announced in January that it was receptive to work requirements, Kentucky swiftly became the first state to gain federal permission. Its requirements were to have been phased in starting in June. But days beforehand, a federal judge blocked them, ruling in a lawsuit that the U.S. Department of Health and Human Services had not adequately considered whether the change would help or hinder Medicaid's central purpose of providing health coverage.

Work requirements are scheduled to begin in early January in Indiana and New Hampshire, the other states with federal permission.