A coalition of five Medicaid beneficiaries, six physician and health organizations and the city of Columbus, Ohio, sued HHS Secretary Robert F. Kennedy Jr., CMS Administrator Mehmet Oz, MD, and their agencies Sept. 18, arguing CMS’ interim final rule on Medicaid work requirements unlawfully narrows who qualifies as “medically frail” and exempt from the mandate.
The lawsuit, filed in the U.S. District Court for the District of Maryland, includes plaintiffs such as the American College of Physicians, American Academy of Pediatrics, Society for Adolescent Health and Medicine, Doctors for America, New Hampshire Medical Society and New Hampshire Chapter of the American Academy of Pediatrics. The plaintiffs are represented by the National Health Law Program and Democracy Forward.
The lawsuit challenges the same June 1 CMS rule at issue in the 25–state lawsuit filed in June, which a federal judge declined to block in July.
This lawsuit argues the rule violates the Administrative Procedure Act in two ways. First, the plaintiffs argue the rule requires Medicaid beneficiaries who fall into one of the law’s medically frail categories to additionally prove their condition “significantly impairs” their ability to meet work requirements, a standard they contend Congress did not include in the underlying statute. Second, they challenge the rule’s treatment of people with substance use disorders who have been in “stable recovery” for at least five years.
The complaint cites an outside analysis estimating the rule’s additional restrictions will increase annual coverage losses from about 6.4 million people, as originally projected under the law, to roughly 8.2 million, a nearly 30% increase. Plaintiffs argue the rule will harm medically frail individuals with conditions such as cancer, diabetes, HIV and substance use disorders, burden Medicaid providers with uncompensated verification work and increase uncompensated care costs for cities such as Columbus. The lawsuit asks the court to vacate the challenged provisions and block their enforcement.
The work requirements, mandated under last year’s HR 1 reconciliation law, are set to take effect Jan. 1, 2027, although states can implement them earlier. CMS has detailed how the rule defines the medical frailty exemption and verification process. Some states have already begun implementation. For example, Nebraska’s early work requirement checks in August led to an estimated 200 expansion enrollees being denied renewals.
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