Massachusetts Federal Judge Rejects States’ Bid to Block Trump’s Medicaid Work Requirement Rule

By Michael Katz | Thursday, 30 July 2026 09:24 PM EDT
A federal judge in Massachusetts declined to block a Trump administration interim rule that requires “medically frail” Medicaid patients to prove they are physically unable to work in order to keep their insurance.
Two dozen Democrat-led states, two Democratic governors and the District of Columbia filed a lawsuit in late June challenging the interim rule issued by the Centers for Medicare & Medicaid Services, arguing they are suffering irreparable harm because they must spend millions to hire staff and set up new technology systems to verify which Medicaid patients are “medically frail” enough to qualify for an exemption.
But U.S. District Judge Richard Stearns ruled late Wednesday that, although courts have recognized that unrecoverable financial damages resulting from agency action are “sufficient” to establish irreparable harm, he is not convinced that the states “have shown that their expenditures are likely to be totally irrecoverable.”
He cited a provision in the One Big Beautiful Bill Act that requires the federal government to cover 90% of states’ implementation costs. And the “tight timeline” the states complain of was set by Congress, not the Trump administration health officials they sued, he added.
“To the extent that the States attempt to premise irreparability on the 10% of costs not already subject to reimbursement, the court is not persuaded,” Stearns wrote. “The States’ main complaint associated with these costs is the ‘tight timeline,’ under which they must implement the programmatic changes. But it is not clear how much this harm can fairly be attributed to CMS.”
Stearns noted that the court’s denial is not a “reflection or anticipation of its ultimate views on the merits of the underlying litigation.”
The case presents “difficult issues” regarding the scope of Congress’ “delegation of interpretative authority to the Secretary and the faithfulness to Congressional intent with which the Secretary performed his task,” he wrote.
“This, in turn, requires an examination of the data relied upon by the Secretary and the judgments (some medical) that underlay his amplification of Congress’s legislative outline,” Stearns wrote. “These are determinations that, in the view of the court, should be made on a developed record of the kind that informs a court’s decision at the summary judgment stage of a case.”
Stearns denied the injunction request without prejudice, meaning the states can request an injunction again if new evidence of harm arises as the work requirement is implemented.
He also stressed that their challenge might prevail down the road, noting that the case raises questions about whether the agency adopted a stricter definition of medical frailty than the states say Congress authorized.