States sue Trump administration over Medicaid work requirements

A coalition of states has initiated a new legal challenge against the Trump administration, seeking to delay the implementation of federal Medicaid work requirements. This action follows a federal district court ruling on Oct. 29, 2026, which partially blocked the administration's interim final rule regarding medical frailty exemptions.

The lawsuit contests the implementation of the 2025 budget reconciliation law, which requires most Medicaid expansion enrollees to log 80 hours per month of work, education, job training, or community service to maintain their coverage. States involved in the litigation, including Minnesota, Oregon, New Mexico, and Washington, argue that the current federal rules impose unauthorized administrative burdens that could lead to coverage losses for vulnerable populations.

The Oct. 29 ruling by a federal judge in Massachusetts determined that the Centers for Medicare & Medicaid Services, led by Administrator Dr. Mehmet Oz, exceeded its authority by creating a restrictive definition for medical frailty exemptions. The court vacated this definition and granted states a six-month stay of enforcement to allow for adjustments to their systems.

Michigan Attorney General Dana Nessel stated that the court's decision serves as a check on the administration and emphasizes the need to protect medically vulnerable individuals from complex paperwork requirements. While the court addressed the medical frailty definition, other provisions of the rule, such as data-review requirements and restrictions on self-attestation, remain in place.

Despite the ongoing legal proceedings, the federal work requirements are scheduled to take effect on Jan. 1, 2027. The court-ordered stay provides additional time for states to manage the transition, though the underlying mandate remains a point of contention between the states and the federal government.