Public Health — News & Analysis

Judge rejects lawsuit from 26 states challenging Medicaid work requirements (July 30, 2026)

BOSTON, July 30, 2026 — A federal judge has declined to block the Centers for Medicare & Medicaid Services from enforcing its Medicaid work requirements rule, leaving the January 1 implementation date intact. Judge Richard Stearns of the U.S. District Court for the District of Massachusetts ruled Wednesday against the coalition of states that had sought a preliminary injunction, Chad Van Alstin reports for Health Exec.

Stearns found that the states had not shown they would be irreparably harmed by complying with the policy. He was not persuaded that the burden of making eligibility determinations under the new framework rose to the level warranting emergency relief, noting that CMS will cover 90% of the costs states incur standing up the new eligibility systems. Questions of that kind, he wrote, "should be made on a developed record" of the sort produced at the summary judgment stage.

The states, led by California and Massachusetts, had targeted the rule's exclusions — above all its definition of who counts as medically frail. Massachusetts Attorney General Andrea Joy Campbell, announcing the filing, characterized the rule as an abrupt change that would make it appreciably harder for vulnerable people both to qualify for exclusions and to keep their coverage at all. Their broader argument was one of capacity: CMS did not release the framework until June, and the states contend they lack the resources to build and run the required systems on the timeline they have been given.

Stearns declined to reach the states' Administrative Procedure Act claim — the contention that CMS exceeded its authority to enforce what Congress actually passed. He made no determination on its merits, which leaves the question available to future litigation. Whether the states will appeal or file again is not yet known.

For now the schedule holds. Work requirements take effect January 1, and states must notify beneficiaries of the change before the end of August.