A coalition of medical associations, municipalities, and low-income residents launched a federal legal challenge Friday against the administration’s implementation of work requirements for Medicaid recipients. The lawsuit targets regulations that restrict exemptions for individuals with significant health challenges.
The legal action stems from the One Big Beautiful Bill Act, which President Donald Trump signed into law last summer. The legislation mandates that adults receiving Medicaid through expansion provisions or waiver programs in 44 states must engage in employment, schooling, or community service to maintain coverage.
While the statute includes exemptions for those who are medically frail, plaintiffs argue that a federal rule issued in June severely narrows who qualifies. The administration’s guidance requires applicants to demonstrate that their conditions actively hinder their ability to work or participate in community engagement. Eligible exemptions include blindness, disability, substance use disorders, disabling mental health conditions, and serious or complex medical issues.
The complaint was filed in the U.S. District Court for the District of Maryland. Enrollee plaintiffs hail from Kentucky, Illinois, Indiana, Missouri, and North Carolina. They are represented by the National Health Law Program and the Democracy Forward Foundation.
Joining the individual plaintiffs are several prominent medical organizations, including the American College of Physicians, the American Academy of Pediatrics, the Society for Adolescent Health and Medicine, Doctors for America, and the New Hampshire Medical Society. The city of Columbus is also a plaintiff, asserting that work requirements will increase financial burdens on municipalities.
Columbus City Attorney Zach Klein argued that administrative barriers to coverage endanger lives and raise costs for public health systems. “Creating barriers to healthcare coverage for the most vulnerable needlessly puts people’s lives at risk and inevitably drives up the cost of care for everyone,” Klein said.
Individuals named in the lawsuit suffer from conditions such as autism spectrum disorder, obsessive compulsive disorder, bipolar disorder, severe vision impairments, HIV, and narcolepsy. Plaintiffs contend that the new verification processes create excessive red tape, threatening coverage for those with serious or chronic health conditions like cancer and diabetes.
Republican lawmakers maintain that work requirements encourage workforce participation and reduce reliance on government aid. However, research indicates that the majority of Medicaid recipients already work or attend school.
Medical groups warn that reporting burdens will cause interruptions in care for low-income, vulnerable adults. Dr. Jan K. Carney emphasized the danger to patient continuity. “We should not and must not be implementing policies that place this already vulnerable population at increased risk of interrupted treatment, disrupted coverage, or losing healthcare access altogether,” Carney said.