FRANKFORT — (AP) — A federal judge has once again blocked new rules for Kentucky’s Medicaid program that would require those seeking to keep their health benefits to either get a job, go to school or volunteer.

The ruling by U.S. District Judge James E. Boasberg, in Washington, D.C., posed a new setback to Republican Gov. Matt Bevin’s efforts to overhaul the state’s Medicaid program after its dramatic expansion under the federal health care overhaul.

Bevin has vowed to end Medicaid benefits for more than 400,000 people in Kentucky if the courts ultimately block his proposed rules. He says the state can’t afford to keep paying its share for that many people. It’s one reason the Trump administration argued it was important to approve the new rules.

But Boasberg said that argument “makes little sense.” He noted if all it took for a state to get new Medicaid rules was to threaten to end coverage, then the federal government would be powerless to stop any proposed rule changes.

“Could a state decide it did not wish to cover pregnant women? The blind? All but 100 people currently on its Medicaid rolls? The (Trump administration) offers no reason that (its) position would not allow for any of those results,” Boasberg wrote.

Bevin told The Associated Press on Wednesday that Boasberg is “one guy in Washington who thinks he owns Kentucky.” Asked if the state would appeal the ruling, Bevin said: “Of course.”

“Every one of the able-bodied people taking (Medicaid), is taking it right out of the hands, right out of the mouths and right out of the pockets of the people for whom Medicaid was designed,” Bevin said. “We are going to stay the course and no one rogue judge in Washington, D.C., is going to dictate what the people of Kentucky do to develop our workforce, to develop our people and to make Kentucky the best version of itself.”

Medicaid is a joint federal and state health care program for the poor and disabled. Former President Barack Obama’s signature health care law allowed states to expand the program to include adults with no children. In Kentucky, that allowed more than 400,000 people to get health benefits, many for the first time.

But that was a lot more people than state officials had expected, greatly increasing the state’s costs. Bevin has been trying to change the program since he was elected governor in 2015. In January 2018, the Trump administration gave Kentucky permission to require some Medicaid recipients to get a job, go to school or volunteer to keep their benefits. The state also planned to impose small monthly premiums from those Medicaid recipients to mimic private insurance plans.

Sixteen Kentucky residents sued to block those rules, with the help of advocacy groups National Health Law Program, Kentucky Equal Justice Center and the Southern Poverty Law Center.

In June, Boasberg blocked the rules from taking effect because he said the Trump administration did not adequately consider how the changes would impact people who receive the health benefits.

In November, the Trump administration approved the rules a second time. The 16 Kentuckians, with the help of their lawyers, again asked Boasberg to block the rules. Wednesday, he did.

“The changes, we have said all along, were harmful, unnecessary and unlawful,” said Ben Carter, a lawyer for the Kentucky Equal Justice Center who argued the case. “We’re thrilled people are going to keep coverage.”

Adam Meier, secretary for the Kentucky Cabinet for Health and Family Services, said the judge’s ruling was illogical.

“The judge illogically concluded that Medicaid is all about paying for healthcare for as many people as possible without regard to whether this coverage actually makes people healthier,” Meier said in a news release from the agency. “We emphatically disagree because a healthcare program like Medicaid, by its very nature, must take into account whether it improves people’s health. That’s the whole point.”