Dozens of states sue Trump administration over 'frail' Medicaid work requirement exemption
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A coalition of 25 states and the District of Columbia is suing the Trump administration over a new rule implementing Medicaid work requirement exemptions for medically frail people.
According to the lawsuit, which was filed Monday in federal district court in Massachusetts, the Centers for Medicare and Medicaid Services (CMS) violated congressional protections when it issued an interim final rule concerning who is eligible for exemptions from new Medicaid work requirements.
The lawsuit alleges the administration adopted a rule that “dramatically narrowed the Congressionally established exclusions from the work requirement for some of the most vulnerable Medicaid members.”
The states argue the new rule will lead people who are either already working or eligible for an exclusion to lose or be denied coverage.
The rule “creates new requirements that constrain who is exempt due to their medically frail status and force medically frail individuals in need of healthcare to jump through unnecessary administrative hoops to get and retain life-saving healthcare coverage,” the lawsuit argues.
The rule issued earlier this month is meant to guide 42 states and the District of Columbia in carrying out the work rules implemented by the One Big Beautiful Bill Act. GOP lawmakers and administration officials have described the policy as a way to combat waste, fraud and abuse in the Medicaid program.
The work requirements are set to take effect in January. Beneficiaries who are part of the Medicaid expansion population must work or volunteer at least 80 hours per month, attend school at least part time or participate in job training.
The law included a series of exceptions for certain vulnerable populations, including a carve-out for people who are “medically frail.” But there was no clear definition of what that meant.
The new rules implicitly link the definition of medical frailty to a person’s ability to work. To qualify for an exemption, a person must demonstrate that their condition prevented them from meeting the work requirement.
States had been discussing implementation plans with the CMS for months ahead of the rule and were blindsided by the much stricter definition. The new standard was not included in the law.
As a result, states argued people who should be protected under the law may lose coverage because they cannot get through the administrative barriers to prove they qualify.
“These changes fly in the face of substantial evidence that was or should have been considered by the agency in its decisionmaking, without adequately considering reasonable alternatives or significant downsides, and without making clear what is being asked of Plaintiff States,” the lawsuit argued.
The states claimed Congress was deliberately broad when they wrote the law.
“But H.R. 1’s broad statutory exclusions exist for good reason. People with disabilities, patients in the middle of cancer treatment, or those struggling with another serious or complex health condition, shouldn’t be at risk of losing the care that helps maintain their health,” the lawsuit states.
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Read the full story at Axios ↗ · The Hill ↗
Twenty-five states and Washington D.C. filed suit in federal district court in Massachusetts challenging how the Centers for Medicare and Medicaid Services defined exemptions from new Medicaid work requirements. The law passed earlier this year requires most Medicaid beneficiaries to work or volunteer at least 80 hours monthly, attend school part-time, or participate in job training starting in January. The law included exemptions for medically frail people but did not define that term. The CMS issued guidance this month that states say restricts who qualifies for exemptions by linking frailty to ability to work and adding administrative requirements. States argue this contradicts Congress's intent to provide broad protections for vulnerable populations and will cause people to lose coverage. The administration describes the work requirements as a measure to address program inefficiency.
Read the full story at Axios ↗ · The Hill ↗
Skip to content
A coalition of 25 states and the District of Columbia is suing the Trump administration over a new rule implementing Medicaid work requirement exemptions for medically frail people.
According to the lawsuit, which was filed Monday in federal district court in Massachusetts, the Centers for Medicare and Medicaid Services (CMS) violated congressional protections when it issued an interim final rule concerning who is eligible for exemptions from new Medicaid work requirements.
The lawsuit alleges the administration adopted a rule that “dramatically narrowed the Congressionally established exclusions from the work requirement for some of the most vulnerable Medicaid members.”
The states argue the new rule will lead people who are either already working or eligible for an exclusion to lose or be denied coverage.
The rule “creates new requirements that constrain who is exempt due to their medically frail status and force medically frail individuals in need of healthcare to jump through unnecessary administrative hoops to get and retain life-saving healthcare coverage,” the lawsuit argues.
The rule issued earlier this month is meant to guide 42 states and the District of Columbia in carrying out the work rules implemented by the One Big Beautiful Bill Act. GOP lawmakers and administration officials have described the policy as a way to combat waste, fraud and abuse in the Medicaid program.
The work requirements are set to take effect in January. Beneficiaries who are part of the Medicaid expansion population must work or volunteer at least 80 hours per month, attend school at least part time or participate in job training.
The law included a series of exceptions for certain vulnerable populations, including a carve-out for people who are “medically frail.” But there was no clear definition of what that meant.
The new rules implicitly link the definition of medical frailty to a person’s ability to work. To qualify for an exemption, a person must demonstrate that their condition prevented them from meeting the work requirement.
States had been discussing implementation plans with the CMS for months ahead of the rule and were blindsided by the much stricter definition. The new standard was not included in the law.
As a result, states argued people who should be protected under the law may lose coverage because they cannot get through the administrative barriers to prove they qualify.
“These changes fly in the face of substantial evidence that was or should have been considered by the agency in its decisionmaking, without adequately considering reasonable alternatives or significant downsides, and without making clear what is being asked of Plaintiff States,” the lawsuit argued.
The states claimed Congress was deliberately broad when they wrote the law.
“But H.R. 1’s broad statutory exclusions exist for good reason. People with disabilities, patients in the middle of cancer treatment, or those struggling with another serious or complex health condition, shouldn’t be at risk of losing the care that helps maintain their health,” the lawsuit states.
Copyright 2026 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Read the full story at Axios ↗ · The Hill ↗
A coalition of 25 states and D.C. sued the Trump administration over Medicaid work requirement exemption rules The Centers for Medicare and Medicaid Services issued an interim final rule concerning who qualifies for exemptions from Medicaid work requirements The new rule narrows congressional protections for medically frail people Medicaid work requirements take effect in January and require beneficiaries to work or volunteer 80+ hours monthly, attend school part-time, or participate in job training The law included exemptions for medically frail individuals but provided no clear definition The new rule defines medical frailty by linking it to ability to work and requires individuals to demonstrate their condition prevents work compliance to qualify for exemptions States were not aware the CMS would issue such strict guidance despite months of implementation discussions The new standard was not included in the original law The rule will cause people who should be protected to lose coverage because they cannot overcome administrative barriers Congress deliberately wrote broad exemptions for people with disabilities, cancer patients, and those with serious health conditions The administration says work requirements combat waste, fraud, and abuse in Medicaid
Read the full story at Axios ↗ · The Hill ↗
- A coalition of 25 states and D.C. sued the Trump administration over new Medicaid work requirement exemption rules for medically frail individuals
- The Centers for Medicare and Medicaid Services issued an interim final rule that states argue narrowed congressional protections for vulnerable populations
- The new rule ties medical frailty exemptions to ability to work, creating administrative barriers states say will deny coverage to eligible people
- Medicaid work requirements are set to take effect in January, requiring beneficiaries to work or volunteer 80+ hours monthly or participate in education/training
- The administration says the policy combats waste and fraud; states argue Congress deliberately wrote broad exemptions for people with disabilities and serious health conditions