Arizona has become the only state in the country where Native Americans are allowed Medicaid benefits without fulfilling work requirements. At the same time, 120,000 non-native state residents must comply. The announcement came Friday from the Centers for Medicare and Medicaid Services.

Last year, the agency said exempting tribes from Medicaid work or volunteer requirements could violate equal protection laws. Across the country, tribes said that position ignored Supreme Court rulings that allow federally recognized tribes to be treated differently, as well as treaties that promised healthcare and other help in exchange for land.

Across Indian country, unemployment rates are consistently much higher than the rest of the nation. And the Indian Health Service is often under-funded.

The exemption in Arizona sets a precedent for other states with high Native American populations. Eight states have requested similar exemptions.