A coalition of 25 Democratic-led states and the District of Columbia has moved to court to halt the Trump administration’s new Medicaid work requirement rule, arguing that it unfairly restricts protections for recipients with serious health conditions and could leave vulnerable Americans without healthcare coverage.
The lawsuit, filed in a federal court in Boston, challenges regulations recently issued by the U.S. Centers for Medicare & Medicaid Services (CMS) to implement the Medicaid work requirements contained in President Donald Trump’s “One Big Beautiful Bill Act.”
At the heart of the dispute is how the administration interprets exemptions for individuals with significant medical needs. According to the states, Congress intended broad safeguards for people who are medically frail or have special medical conditions. However, the CMS rule allegedly raises the threshold by requiring recipients to prove that their condition “significantly impairs” their ability to work before they can qualify for an exemption.
The plaintiffs argue that this additional requirement creates unnecessary bureaucratic barriers, forcing people with serious illnesses to navigate extra paperwork simply to retain their government-funded health insurance.
Under the law enacted by the Republican-controlled Congress, most Medicaid beneficiaries between the ages of 19 and 64 will be required to complete at least 80 hours each month of employment, community engagement, or qualifying educational activities to remain eligible for coverage. Certain categories of recipients are exempt from the mandate.
CMS issued interim guidance earlier this month to help states prepare for the rollout of the new requirements.
The lawsuit contends that the agency exceeded its legal authority by narrowing the exemptions established by Congress. It also alleges that the rule violates the Administrative Procedure Act and imposes unconstitutional conditions tied to federal spending.
The coalition is seeking to prevent the rule from taking effect before its scheduled implementation on January 1. The states argue that immediate judicial intervention is necessary because they must begin notifying Medicaid beneficiaries of the upcoming changes by August 31, leaving limited time to revise administrative systems and compliance procedures.
Massachusetts Attorney General Andrea Joy Campbell criticized the policy, saying the administration’s approach places unnecessary burdens on Medicaid recipients and risks limiting healthcare access for vulnerable individuals and families.
The U.S. Department of Health and Human Services, which oversees CMS, had not publicly responded to the legal challenge at the time the case was filed.
If successful, the lawsuit could delay or reshape one of the Trump administration’s most significant Medicaid policy changes, setting up another major legal battle over the scope of federal authority in administering public healthcare programs.
