Map Shows 26 States Suing Trump Administration Over Medicaid Rule

Twenty-five states and Washington, D.C., have filed a lawsuit against the Trump administration over a new Medicaid rule. The rule would require many low-income adults to show they are working, studying, or volunteering at least 80 hours a month to keep their health insurance. The states say this rule is unfair and could cause millions of people who qualify for coverage to lose it anyway.

Medicaid is a government health insurance program that helps people with low incomes pay for medical care. More than 67 million Americans are enrolled in Medicaid right now. The new rule does not affect every person on Medicaid, but it could impact millions of adults who got coverage through an expansion of the program created by the Affordable Care Act.

The rule was released by the Centers for Medicare and Medicaid Services, known as CMS, in June. Under the rule, most states must have the new requirements in place by January 1, 2027. Adults between the ages of 19 and 64 who get coverage through the Medicaid expansion program would need to complete at least 80 hours of approved activity each month. Those activities can include working a job, doing community service, going to school at least half-time, or joining a job training program.

The lawsuit was filed on June 29 in a federal court in Massachusetts. It is led by attorneys general from California, Massachusetts, and New Jersey. The states are asking the court to block parts of the rule from taking effect.

The states argue that the new rule creates too many paperwork hurdles. They say some people could lose their coverage even if they are already working or should be exempt, simply because they can't prove it in time. If a person cannot show they meet the requirements, the rule gives them just 30 days to provide proof before their coverage can be taken away.

The lawsuit also says the rule makes it harder for people with serious health problems to keep their insurance. The states argue that people with disabilities, cancer patients, and others with complex medical needs could lose coverage because of new reporting requirements. They point to past Medicaid work requirement programs, which showed that red tape caused some people who qualified to lose their benefits anyway.

States say the rule also puts pressure on state health agencies. Those agencies would have to update their computer systems, contact all affected people, and put the new rules in place very quickly. The states also say CMS released this new rule after they had already started preparing for a different version of the requirements, creating confusion and extra costs for state governments.

Massachusetts Attorney General Andrea Joy Campbell said the administration's plan 'threatens access to healthcare for our most vulnerable residents and families.' She added that Congress had made clear that people with serious medical conditions should not lose their coverage. She said the states are asking the court to block the unlawful parts of the rule.

CMS Administrator Dr. Mehmet Oz defended the rule. He said work requirements will help 'Americans build skills and independence through work, education, job training, or community service.' He said these opportunities would create new chances for people and their families.

The lawsuit also has a political angle. Of the 26 places involved, 20 voted for Democrat Kamala Harris in the 2024 presidential election, while six voted for Republican Donald Trump. Six of those states are considered presidential battleground states, meaning voters there often switch between parties. Because so many competitive states are involved, the fight over Medicaid work requirements could play a big role in future elections.