Federal Judge Lets Trump's Medicaid Work Requirements Proceed as 26 States Say They Cannot Meet the Deadline

U.S. District Judge Richard Stearns of Massachusetts on July 30 denied a preliminary injunction sought by 26 states and the District of Columbia against the interim final rule implementing Medicaid work requirements, which the Centers for Medicare and Medicaid Services issued in June. The rule requires expansion-population adults to work, study or volunteer at least 80 hours a month, takes effect Jan. 1, 2027, and obliges states to notify enrollees by Aug. 31. The states argued they lack the staff and capacity to meet that timeline and that the rule narrowed the exemptions Congress wrote. Stearns found they had not shown irreparable harm, noting CMS had agreed to reimburse 90 percent of implementation costs and that the timeline "was set by Congress in H.R. 1, not by CMS."

The requirement applies across the 42 states and the District of Columbia that expanded Medicaid, so the administrative machinery for verifying compliance and processing exemptions must be stood up quickly and at scale. Coverage losses in prior state-level work-requirement experiments came largely from paperwork failures rather than from people declining to work, which is what the plaintiff states pointed to in seeking a pause.

The denial was without prejudice and the case proceeds to a hearing on the merits, which Stearns said he hopes to schedule before the January implementation date. He wrote that the case "presents difficult issues regarding the scope of Congress's delegation of interpretative authority to the Secretary," and said the states may renew their request if the case stalls.