Democratic states sue to block Medicaid work-requirement rule

A coalition of Democratic-led states filed suit against the Trump administration, seeking to block a rule that would impose new work requirements on Medicaid recipients, arguing the measure unlawfully restricts exemptions for people with serious medical conditions.

The lawsuit, brought by 25 states and the District of Columbia in federal court in Boston, contends that the rule forces medically frail individuals to navigate unnecessary administrative hurdles in order to retain government-funded health insurance.

The rule, issued by the Centers for Medicare & Medicaid Services (CMS), implements work requirements enacted under President Donald Trump's tax and spending legislation, known as the One Big Beautiful Bill Act. Medicaid, the US government health insurance program for low-income Americans, is funded jointly by federal and state governments.

Under the law, passed by the Republican-led Congress, adults aged 19 to 64 must complete a minimum of 80 hours per month of work or community engagement activities, or be enrolled at least half-time in an education program, in order to qualify for coverage, with limited exceptions. CMS issued interim guidance to states earlier in June on how to implement the requirements.

The states argue that Congress intended broad exemptions from the work mandate for individuals who are "medically frail or otherwise have special medical needs." They say CMS's rule narrowed those protections by requiring people with significant medical conditions to demonstrate that their condition "significantly impairs" their ability to work.

"The Trump Administration's attempt to impose new, burdensome requirements on Medicaid recipients threatens access to healthcare for our most vulnerable residents and families," said Andrea Joy Campbell, the Massachusetts attorney general.

CMS, part of the US Department of Health and Human Services, did not respond to a request for comment.

The states claim the rule unlawfully narrows the exemptions Congress established, violates the Administrative Procedure Act, and imposes unconstitutional conditions on federal spending.

The work requirement is scheduled to take effect on January 1, but states must notify Medicaid recipients of the changes by August 31 — a timeline the plaintiffs say leaves insufficient room to adjust implementation plans, and which they argue justifies blocking enforcement of the rule.