Four states take HHS to court over Medicaid work requirements

Four states are taking the federal government to court over Medicaid work requirements, with less than 60 days until the Jan. 1 implementation deadline. State attorneys general from Oregon, Minnesota, New Mexico, and Washington filed the suit arguing that the Centers for Medicare & Medicaid Services (CMS) lacked constitutional authority to impose the requirements and that the policy infringes on states' sovereign interests.

The work requirements — passed as part of the GOP's "Big Beautiful Bill" in July 2025 — mandate that Medicaid recipients enrolled through the ACA's Medicaid expansion complete 80 hours of work, volunteering, or schooling per month to keep their coverage. The plaintiffs argue this effectively transforms Medicaid into an entirely new program, which prior court rulings suggest the CMS cannot do while threatening existing federal funding.

Key Takeaways:

• The lawsuit seeks a declaration that withholding federal Medicaid funds is unconstitutional, plus a preliminary and permanent injunction on funding cuts
• States warn of rising uncompensated care costs as uninsurance rates climb
• An October ruling already struck down the "medical frailty" exemption provision, adding further legal uncertainty to the rollout

Why it matters: With the Jan. 1 deadline looming, mounting legal challenges could delay or derail implementation — leaving states, providers, and millions of Medicaid enrollees in limbo.