Pa., N.J. and Del. join multistate lawsuit against Trump administration over Medicaid work requirements

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Leaders from Pennsylvania, New Jersey and Delaware are suing the federal government over impending Medicaid work requirements that they say will cause people to lose health insurance and create “chaos” for states to implement.

Specifically, the lawsuit claims that the Trump administration’s new guidance on who can qualify for a medical frailty exemption is too restrictive and burdensome, and will not protect people with illnesses or disabilities from the new rules.

“We are suing to stop this cruel and unlawful rule,” New Jersey Attorney General Jennifer Davenport said in a statement. “I will continue to fight against unlawful efforts that would increase costs to people with serious illnesses and disabilities.”

The lawsuit, filed Monday in U.S. District Court in Massachusetts, is led by Democrat attorneys general and governors in 25 states and the District of Columbia.

It seeks to block implementation of the new Medicaid work guidelines and provisions while the lawsuit is active.

What are the new Medicaid work requirements?

The new work rules for Medicaid, a safety net program for people with low incomes, are scheduled to take effect in January 2027. Congress passed them in H.R. 1, or the “One Big Beautiful Bill Act,” which President Donald Trump signed into law last July.

The rules apply to people ages 19 to 64 who are in states’ Medicaid expansion populations. That’s about 750,000 people in Pennsylvania alone, including more than 183,000 Philadelphians, according to state data.

Enrollees in Medicaid programs must work at least 80 hours a month starting in January. Volunteering or being in school, at least part-time, can also count toward the requirement.

Participants must show proof and complete annual enrollment eligibility paperwork to stay in compliance and keep their insurance coverage.

Medicaid work requirement exemptions

Over the last year, federal health officials stated that certain people and groups would be exempt from these requirements, including women who are pregnant or have recently given birth, people with disabilities or medical conditions, parents and caretakers of children age 13 and younger or people with disabilities, those in treatment for alcohol or drug addiction, American Indians, Alaska Natives, and others.

The Centers for Medicare & Medicaid Services released interim guidance on June 1 about how states should process medical frailty exemptions and under what circumstances.

The definition stipulates that in addition to having a qualifying condition, people must prove that their medical frailty will “significantly impair their ability to comply with the [work] requirement,” the federal agency stated.

People will be able to self-attest their condition under the frailty definition throughout 2027 and once in 2028, but will then need to provide proof. Otherwise, they risk losing Medicaid health insurance.

Democrats in the lawsuit argue that the work requirements and exemption rules are unconstitutional and violate federal administrative procedural law.

“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,” plaintiffs wrote in court documents. “Nowhere in H.R. 1 does Congress state that individuals’ ability to work must be impaired in order to be ‘medically frail or otherwise have special medical needs,’ or to have a ‘serious or complex medical condition.’”

Pennsylvania Gov. Josh Shapiro blamed the president, Dr. Mehmet Oz, the head of the Centers for Medicare & Medicaid Services, and Health Secretary Robert F. Kennedy Jr. “for trying to rip away Medicaid from Pennsylvanians who need it most.”

“Donald Trump, Dr. Oz, and RFK Jr. are hellbent on trying to push aside people who rely on Medicaid to get the care they need,” Shapiro said in a statement on social media. “But here in Pennsylvania, we’re going to keep standing up to protect our most vulnerable Pennsylvanians.”