Tribal nations in Maine and around the country say a push backed by President Trump’s administration to require certain Medicaid recipients to work or volunteer conflicts with the federal government’s responsibility to provide health care to Native Americans.

Meanwhile, the Centers for Medicare and Medicaid Services told tribal leaders Wednesday that requiring states to exempt Native Americans from work requirements could raise civil rights issues.

The Trump administration recently required states to consult with tribes before imposing work requirements.

Penobscot Nation Chief Kirk Francis and tribal advocacy groups say work requirements would jeopardize coverage and shift health costs elsewhere, including the overburdened Indian Health Service.

Some states that have proposed work requirements have already moved to protect Native Americans from potentially losing Medicaid benefits.