A federal judge has denied a request by Massachusetts and 25 other states to block new work requirements for Medicaid recipients, allowing the rule to move forward as planned. The decision, issued by U.S. District Judge Richard Stearns on July 30, clears the way for states to implement the requirements by January 1, 2027, under the One Big Beautiful Bill Act passed in 2025.
The ruling rejects arguments from the states that the requirements would impose significant costs and tight deadlines. Judge Stearns noted that the federal government will cover 90% of the costs, and the timeline was set by Congress, not the Centers for Medicare and Medicaid Services (CMS). The states had also objected to the guidance on determining who qualifies as 'medically frail' and the need to notify recipients by September 1.
The rule mandates that Medicaid recipients aged 19 to 64 must work, volunteer, or participate in job training for at least 80 hours per month. Exemptions apply for those deemed 'medically frail.' If recipients fail to comply, they risk losing coverage unless they can prove their inability to work.
Massachusetts Attorney General Andrea Campbell, who co-led the lawsuit, argued that the changes leave states insufficient time to adjust their implementation plans. Meanwhile, supporters of the rule, including the Trump administration, argue it promotes self-sufficiency among Medicaid beneficiaries.
The case will now proceed, with the court set to rule later on the broader legal challenge to the work requirements.