25 States Sue Trump Administration Over Medicaid Work Requirements

A coalition of 25 states and the District of Columbia filed a lawsuit in the U.S. District Court in Massachusetts to block a Trump administration rule regarding Medicaid work requirements. The legal challenge targets an interim final rule issued by the Centers for Medicare and Medicaid Services (CMS) and the U.S. Department of Health and Human Services, which narrows the definition of medical frailty.

Under the new guidance, individuals with serious conditions, such as cancer or heart disease, must demonstrate that their illness significantly impairs their ability to work, volunteer, or attend school to qualify for an exemption. Starting January 1, 2027, expansion enrollees aged 19 to 64 must document 80 hours of monthly work or community service, or be enrolled in school at least half-time, to maintain coverage. The lawsuit alleges the rule oversteps legal authority, violates the Administrative Procedure Act, and imposes an impossible implementation timeline, with beneficiary notifications due by August 31, 2026.

Plaintiffs, including attorneys general from California, Massachusetts, and New Jersey, argue the rule creates harmful bureaucratic barriers for vulnerable populations. State officials warn of significant coverage losses, with Wisconsin anticipating impacts to 800,000 members of the BadgerCare Plus program and Minnesota projecting losses for 128,000 residents. Conversely, administration officials describe the requirements as commonsense measures designed to promote independence and eliminate government freeloading.