On June 29, a coalition of 25 states and the District of Columbia filed a lawsuit in Boston federal court to block a Trump‑era rule that imposes work requirements on Medicaid recipients. The plaintiffs argue the rule forces medically frail adults to meet unnecessary hurdles, shrinking the exemptions Congress originally granted for patients who cannot work today.

Congress passed the One Big Beautiful Bill Act tax and spending law, mandating adults 19‑64 to log at least $80 hours of work or community service each month or enroll in a half‑time education program to stay on Medicaid. CMS issued an interim rule last month to guide states on implementation and ensure compliance across states today.

State attorneys general argue CMS’s rule trims the broad exemptions that protect medically frail people, demanding they prove a significant impairment to work. They claim the rule violates the Administrative Procedure Act and the Constitution, and that the August 31 notice deadline gives states too little time to adjust, risking loss of coverage for thousands in 2024.

CMS has not yet responded to the complaint. If the court dismisses the suit, the work requirement will take effect on January 1, 2025, forcing millions of low‑income Americans to meet a mandatory employment benchmark that could jeopardize their health coverage and strain state Medicaid budgets today.