25 states sue to block Trump Medicaid work requirement rule

A coalition of 25 states and the District of Columbia sued the Trump administration in Boston federal court on June 29, 2026, seeking to block a Medicaid rule that would require many adults to log 80 hours a month of work, education, job training, volunteer service or similar activity to keep coverage. The rule was issued by the Centers for Medicare & Medicaid Services on June 1 and implements work requirements written into the One Big Beautiful Bill Act.

The complaint says the administration narrowed the exemption for people who are medically frail, even though Congress created exclusions to protect people with serious illnesses and disabilities. It says the federal rule would force vulnerable enrollees to jump through unnecessary administrative hoops and could cause eligible people to lose health coverage because of paperwork and repeated reporting. Massachusetts co-led a 26-state coalition.

States must generally implement the requirement no later than Jan. 1, 2027, and Congress directed them to notify Medicaid recipients by Aug. 31, 2026. The framework standardizes state implementation, but the lawsuit argues that the federal government changed the rules too abruptly and left state agencies with too little time to rebuild eligibility systems, verify hours and track exemptions.

The Congressional Budget Office has estimated that the work-requirement provisions will cut federal Medicaid spending by $326 billion over 10 years, and KFF estimates the broader 2025 reconciliation law reduces federal Medicaid spending by $911 billion over the decade, with work requirements accounting for more than one-third of that total. KFF and CBO project 4.8 million more people uninsured in 2034 because of the requirement. Arkansas’s 2018 work rule led 18,000 adults to lose Medicaid coverage before a federal judge halted it, and Harvard researchers found no increase in employment.