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States Sue Trump Administration Over Medicaid Work Requirements
Confirmed
In Short: States are suing the Trump administration to delay Medicaid work requirements set to take effect in 2027.
Minnesota Attorney General Keith Ellison has joined three other state attorneys general in a lawsuit challenging federal Medicaid work requirements set to take effect in 2027, arguing that the requirements constitute new conditions for participating in Medicaid and pose the 'threat of crushing financial penalties,' running afoul of the US Constitution’s spending clause.
The 2025 reconciliation law, signed by President Trump on July 4, 2025, requires 44 states (including DC) to condition Medicaid eligibility for adults in the Affordable Care Act (ACA) Medicaid expansion group and certain enrollees in 1115 waiver programs on meeting work requirements starting January 1, 2027. Currently, 41 states (including DC) have expanded their Medicaid programs under the ACA to nearly all adults with income up to 138% FPL ($21,597 for an individual in 2025).
The lawsuit arrives less than 60 days before the January 1, 2027, deadline. Under the new requirement, Medicaid users who are between 18 and 64 years old and without young children must clock 80 hours of work or other qualified activities a month, which is expected to cause up to 10.1 million Americans to lose coverage.
The law requires states to implement new Medicaid eligibility rules beginning in 2027 or risk losing all federal Medicaid funding. About 1.2 million Minnesotans rely on Medicaid, known in the state as Medical Assistance, according to Ellison’s office.
To implement Medicaid work requirements, states will need to make important policy and operational decisions, implement needed system upgrades or changes, develop new outreach and education strategies, and hire and train staff, all within a relatively short timeframe. The nonpartisan Congressional Budget Office estimated that, based on the original law, around 5 million people would become uninsured because of the work requirement, including many people who were working but unable to handle the paperwork to prove it.
The states, which filed the lawsuit Thursday, are employing a legal strategy based on an argument successfully used by conservative states to oppose Obamacare’s Medicaid expansion. In June, Minnesota joined 25 Democratic-led states in suing the Trump administration over its implementation of the work requirements, arguing that the administration’s new “medically frail” designation was too narrow and would make it too difficult for ill and disabled people to remain on Medicaid.
A federal judge on Thursday blocked President Donald Trump's administration from enforcing a rule that would narrow exceptions to new work requirements for Medicaid recipients with serious medical conditions. The law requires adults ages 19 to 64, with a few exceptions, to complete a minimum of 80 hours of work or community engagement activities per month or be enrolled in education programs at least half time to qualify for Medicaid beginning January 1, 2027.
What this adds
The states argue that the work requirements constitute new conditions for participating in Medicaid and pose the 'threat of crushing financial penalties,' running afoul of the US Constitution’s spending clause.
Background
U.S. District Judge Richard Stearns issued an 16-page order blocking the Trump administration's new rule that would have imposed stricter work requirements on Medicaid recipients, siding with a coalition of more than two dozen states.
What's confirmed
- Information released by the Centers for Medicare and Medicaid Services (CMS) on June 8, 2026.
What's still developing
- The list identifies waiver programs in three non-expansion states Georgia, Tennessee, and Wisconsin, as well as in five expansion states, Hawaii, Massachusetts, New York, Oregon, and Utah (Figure 1).
- Minnesotans between the ages of 21 and 64 who apply for Medicaid will need to demonstrate that they have been working, attending school or volunteering for at least 80 hours each month to qualify for or retain health insurance under the joint federal-state program.
- Carline Jean/TNS/Zuma On Monday, officials in 25 states and Washington, DC, sued Health and Human Services Secretary Robert F.
- When Republican lawmakers were threatening to severely slash Medicaid last year as part of the $1 trillion in health care cuts in their One Big Beautiful Bill law, Newell traveled to D.C. to advocate for the program.
- State’s Chaotic Rollout Foreshadows Risks as Nationwide Deadline Draws Near (Washington, DC) – Nebraska’s efforts to implement new, federally mandated work requirements for Medicaid underscore fears that millions of people will experience avoidable barriers to healthcare coverage, Human Rights Watch, Oxfam America, and Nebraska Appleseed said today.
- Federally recognized tribes given exemptions from new work rule At the start of 2027, new work mandates attached to Medicaid will go into effect as a result of the One Big Beautiful Bill Act.
- The U.S. Centers for Medicare and Medicaid Services said in a statement that the agency met with 16 health centers in Hawai’i about Medicaid changes.
Sources
- Bloomberg Law Newslink
- KFFlink
- KTTC | Rochester, MNlink
- MPR Newslink
- Minnesota Reformerlink
- STATlink
- NBC Newslink
- Motherjoneslink
- Seattletimeslink
- Prospectlink
- Northcarolinahealthnewslink
- Upilink
- Hrwlink
- Buffalosfirelink
- WarpBeat — background on Judge Blocks Trump Admin's Strict Medicaid Work Requirements link
- DavidMCEddy — video link