A coalition comprising 25 states and the District of Columbia has filed a lawsuit in a Boston federal court to block a recently implemented Trump administration rule establishing work requirements for Medicaid recipients. The legal filing argues that the federal mandate unlawfully restricts exemptions for individuals with serious medical conditions, thereby imposing unnecessary administrative barriers on those who rely on government-funded health insurance.
The challenged rule was issued this month by the U.S. Centers for Medicare & Medicaid Services (CMS). It operationalizes work requirements originally enacted as part of the "One Big Beautiful Bill Act," a comprehensive tax and spending law passed by the Republican-led Congress. Medicaid, a joint federal-state health insurance program for low-income Americans, is now subject to these new stipulations under the legislation.
Under the enacted law, adults aged 19 to 64 are generally required to engage in a minimum of 80 hours of work or community service activities per month. Alternatively, individuals must be enrolled in an educational program for at least half of their time to remain eligible for Medicaid coverage. CMS released an interim rule earlier this month to provide states with guidance on implementing these requirements.
The lawsuit contends that the CMS rule conflicts with the broader exemptions established by Congress in the "One Big Beautiful Bill Act." While the statute excludes individuals who are "medically frail or otherwise have special medical needs" from work requirements, the states argue that the federal agency has narrowed this protection. Specifically, the CMS rule requires individuals 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," Massachusetts Attorney General Andrea Joy Campbell stated in a public declaration.
The filing asserts that the CMS rule violates the Administrative Procedure Act and imposes unconstitutional conditions on federal spending. Furthermore, the states argue that the timeline for implementation is inadequate. Although the work requirements are scheduled to take effect on January 1, states are mandated to notify Medicaid recipients of the changes by August 31. The lawsuit contends that this timeframe provides insufficient opportunity for states to adjust their implementation plans, warranting a judicial block on enforcement.
CMS, an agency within the U.S. Department of Health and Human Services, did not immediately respond to requests for comment regarding the litigation. The legal challenge underscores the complexities of federal policy implementation in the healthcare sector and the potential fiscal and administrative impacts on state Medicaid systems.