25 states sue over Medicaid work rule for adults

Twenty-five Democratic-led states and the District of Columbia sued in Boston federal court to block a new federal Medicaid work rule they say exceeds what Congress authorized. The challenge targeted a June 1 interim final rule from the Centers for Medicare & Medicaid Services that requires certain adults to show 80 hours a month of work, education, job training or community service.

Filed Monday, June 29, 2026, the case centers on CMS’s definition of medical frailty and the exemptions available to people with serious health conditions. The states contend the agency narrowed those protections after previewing a different approach to state officials, forcing eligible people to clear new administrative hurdles before they can keep coverage.

The rule applies to non-pregnant adults ages 19 through 64 who are not entitled to or enrolled in Medicare and who are in the Medicaid adult group or certain Section 1115 demonstrations. It requires 43 states and the District of Columbia to implement the requirement, generally by January 1, 2027. States may still allow hardship exceptions in some cases, including areas with unemployment and emergencies.

Dr. Mehmet Oz, the CMS administrator, said the policy is intended to promote economic stability, self-sufficiency and independence.

KFF estimates the 2025 reconciliation law, signed by President Donald Trump on July 4, 2025, requires 44 states, including the District of Columbia, to condition Medicaid eligibility for certain adults on meeting work requirements starting January 1, 2027. KFF estimates the law will cut federal Medicaid spending by $911 billion over 10 years and raise the number of uninsured people in 2034 by 10 million, with 5.3 million of that increase tied to work requirements.

Medicaid covers nearly all low-income adults in expansion states, and KFF counts 41 states, including the District of Columbia, as having expanded the program to adults with incomes up to 138% of the federal poverty level.

The Trump administration previously allowed Medicaid work requirements, Arkansas became the first state to enforce one, and federal judges later blocked or halted similar rules in Arkansas, Kentucky and other states.