A coalition of 25 Democratic-led states and the District of Columbia took legal action Monday, filing a federal lawsuit in Boston to halt a Trump administration rule that would require many Medicaid recipients to meet new work requirements.
The states contend the rule unlawfully restricts protections for people who are seriously ill, forcing medically vulnerable individuals to jump through unnecessary bureaucratic hoops just to keep their government-funded health coverage.
The rule was issued this month by the U.S. Centers for Medicare and Medicaid Services, known as CMS, and stems from the work requirements written into President Donald Trump’s “One Big Beautiful Bill Act” — a sweeping tax and spending law passed by the Republican-led Congress.
Medicaid is the federally and state-funded health insurance program that serves low-income Americans across the country.
Under the new law, most adults between the ages of 19 and 64 must complete at least 80 hours of work or community engagement activities each month — or be enrolled at least half time in an educational program — in order to remain eligible for Medicaid coverage.
Earlier this month, CMS released an interim rule to guide states on how to carry out those requirements.
The lawsuit argues that Congress built broad exemptions into the law, including protections for individuals who are “medically frail or otherwise have special medical needs.” However, the states say CMS narrowed those protections by requiring people with significant health conditions to prove that their condition “significantly impairs” their ability to work — a higher bar than what Congress intended.
Massachusetts Attorney General Andrea Joy Campbell addressed the legal challenge in a statement, saying: “The Trump Administration’s attempt to impose new, burdensome requirements on Medicaid recipients threatens access to healthcare for our most vulnerable residents and families.”
CMS, which operates under the U.S. Department of Health and Human Services, did not respond to a request for comment regarding the lawsuit.
The states raise three main legal objections: that the CMS rule improperly narrows Congress’s protections for medically frail Medicaid recipients; that it violates the Administrative Procedure Act; and that it places unconstitutional conditions on federal spending.
Although the work requirement is not set to take effect until January 1, states must notify Medicaid recipients of the upcoming changes by August 31. The states argue that deadline leaves them far too little time to update their systems and implementation plans, and they are asking a court to block the rule before it can be enforced.
