Democratic officials from 25 states and the District of Columbia filed a lawsuit on Monday challenging the Trump administration’s recent guidance on new Medicaid work requirements. The plaintiffs argue that the interim final rule issued this month by the Centers for Medicare and Medicaid Services (CMS) exceeds the authority granted by the law enacted last summer to implement these changes.

The lawsuit, brought by attorneys general and governors, asserts that the administration’s narrow interpretation of key aspects of the statute—including more stringent limits on the medical frailty exemption—will create significant barriers to Medicaid coverage. They warn such restrictions will hinder eligible individuals from accessing necessary health care and generate confusion as states prepare to adopt new systems ahead of the January 1 deadline.

Under the new guidelines, Medicaid enrollees in expansion programs aged 19 to 64 must demonstrate they are working or engaged in community service for at least 80 hours per month, or enrolled in school at least half-time. Exceptions apply for individuals classified as medically frail or those participating in addiction treatment programs, among other categories.

The plaintiffs emphasize that the additional administrative requirements could lead to eligible beneficiaries losing or being denied coverage, particularly given the compressed timeline for states to comply. The lawsuit names the Department of Health and Human Services (HHS) and CMS, though neither agency provided immediate comment.

The dispute highlights ongoing tensions over the federal government’s role in Medicaid administration and the potential impact of imposing work-related conditions on a program traditionally based on income eligibility. Supporters of the rule argue that work requirements encourage personal responsibility and can lead to improved health outcomes, while opponents contend they create unnecessary obstacles for vulnerable populations.

Implementation of the work requirements, which were initially approved by CMS in several states during the Trump administration, has faced delays and legal challenges. This latest lawsuit represents a coordinated effort by Democratic-led governments to block the rollout of the work mandates ahead of the scheduled start in early 2020.