Democrats in half of states sue Trump administration over Medicaid work rules
NEW YORK (AP) — Democrats in 25 states and the District of Columbia sued the Trump administration on Monday. final guidance new Medicaid work requirementsDiscussing strict rules would prevent eligible Americans from accessing the care they need.
Chief prosecutors and governors who filed the lawsuit case It argues that the interim final rule issued by the Centers for Medicare and Medicaid Services earlier this month exceeds the text of the law that set in motion changes to Medicaid last summer.
They argue that the Republican administration’s narrow interpretation of parts of the law, including new limits on the medical disability exemption, will create harmful coverage hurdles and chaos in states rushing to implement new systems by the end of January.
“The added administrative burdens will cause Medicaid-eligible individuals to lose or be denied coverage,” the plaintiffs write. “People with disabilities, patients in the midst of cancer treatment, or those dealing with another serious or complex health condition should not be at risk of losing the care that helps protect their health.”
Spokespeople for the U.S. Department of Health and Human Services and CMS, the agencies named in the lawsuit, did not immediately respond to a request for comment. The Trump administration has promoted the new rules as common-sense measures to eliminate government freeloading and protect benefits for those who need them most.
The new Medicaid restrictions criticized by Democrats were part of Trump’s massive 2025 tax and policy bill. The change affects most states covered by the expansion that gives lower-income people access to the government’s safety net health program.
Starting Jan. 1, expansion enrollees ages 19 to 64 will need to show they work or perform community service for at least 80 hours a month or are in school for at least half of that time. There are exceptions for those deemed medically frail or those in addiction treatment programs, among others.
CMS’s announcement this month caught states off guard with its new definition of medical frailty. The law stated that medically impaired people include people with substance use disorders, disabilities, or serious medical conditions. But the CMS rule goes further, saying a person’s condition must “substantially adversely affect” their ability to work, volunteer, or attend school at the rates required by law to be granted an exemption.
Once in 2027 and once in 2028, the patient may declare that he or she fits this definition. But they will need to prove it when they try to renew the insurance in 2028. Health analysts and state Medicaid administrators said it wasn’t clear whether available documents could prove that point.
In the lawsuit, the states claim that this change “contradicts months of regular communications with CMS and preliminary guidance materials on which Plaintiff States based their implementation plans.” They say CMS still hasn’t provided states with enough clarity on how they can update their systems appropriately.
New York Attorney General Letitia James, one of the Democrats suing the administration, said the new rule puts thousands of residents of her state at risk.
“New Yorkers battling cancer, living with a disability, struggling with a serious mental health issue, or recovering from addiction should be able to get the health care they need without being buried in paperwork,” he said in a statement.
