The head of Medicare and Medicaid on Tuesday defended a controversial Medicaid work requirements program in Arkansas that led to more than 4,000 people losing coverage, saying that the reforms have helped get people out of poverty.

“It about not just saying: ‘Here is your healthcare card,’” said Seema Verma, head of Centers for Medicare & Medicaid Services, speaking at the Atlantic Fest. “We are trying to say that these individuals are living in poverty and they need more than that.”