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BALTIMORE, MD – Attorney General Anthony G. Brown today joined a coalition of 24 attorneys general and two governors in filing a lawsuit over the Trump administration’s unlawful implementation of new Medicaid work requirements included in the One Big Bill Act. Specifically, the lawsuit challenges provisions of an interim final rule published by the U.S. Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) on June 3, 2026. Medicaid is the nation’s safety net healthcare program for low-income Americans and is jointly funded by states and the federal government, with the federal government providing at least 50% of the cost of services.
Congress created exemptions from Medicaid’s work requirements to ensure that people with serious illnesses and disabilities do not lose coverage or face interruptions in care. Despite months of working with states on implementation, CMS surprised states with the interim final rule, “Community Engagement Requirement for Certain Individuals,” which adopted a new interpretation of key terms like “medically frail” and makes it harder for medically vulnerable individuals to be excused from the work requirements. While the work requirement provision applies beginning January 1, 2027, states must notify Medicaid recipients about these changes by August 31, 2026, and need significant lead time to prepare those communications. They cannot wait for CMS to address the deficiencies through the ongoing rulemaking process.
As a result, the attorneys general are seeking to block implementation of the interim final rule’s unlawful provisions and to have them ultimately struck down. States had already made substantial investments in reliance on the plain language of the One Big Bill Act and CMS’s prior guidance and now face the risk of harsh financial penalties for noncompliance with the interim final rule.
“Medicaid recipients include Marylanders managing chronic illnesses, fighting cancer, and struggling to afford the medications that keep them alive,” said Attorney General Brown. “The Trump Administration's new rule unlawfully narrows who qualifies for the exemptions Congress created to protect seriously ill and disabled Americans, stripping their coverage not because they fail to qualify, but because the administration has rewritten the rules to exclude them. We are challenging this unlawful rule because people with serious illnesses and disabilities should not lose lifesaving medical coverage because the administration ignored what Congress wrote.”
“Everyone deserves access to affordable, quality health care, but Trump's unlawful work requirements create unnecessary barriers for those who need care most,” said Gov. Moore. “Maryland will always fight to ensure no one is left behind, and I applaud Attorney General Brown for using every legal tool available to defend the health and safety of our people.”
The interim final rule makes other changes that increase administrative burdens, create unnecessary red tape, and put eligible people at risk of losing their health coverage – including those who are already working or qualify for an exemption. The rule disregards substantial evidence that should have been considered, fails to adequately evaluate reasonable alternatives, and does not give states clear or workable guidance. Past Medicaid work requirement programs have shown that added red tape causes eligible people to lose coverage, placing greater strain on state Medicaid programs, safety net providers, and emergency rooms, while increasing costs as more medically frail residents become uninsured.
Unless enjoined, the interim final rule threatens serious harm on Maryland and its residents. For instance, internal analysis conducted after the interim final rule was released suggests that 150,000 Affordable Care Act (ACA) adult expansion members in Maryland, or at least 45 percent of Maryland Medicaid’s ACA adult expansion members, will be disenrolled at some point following implementation of the interim final rule. And this estimate may understate the likely impact, as the interim final rule now requires “medically frail” individuals to demonstrate significant impairment to their ability to work. The interim final rule will also impose, among other burdens, an estimated 20% increase in state administrative costs (at least $2 million in Maryland state funds) to handle the increased complexity mandated by the rule.
In today’s lawsuit, the coalition alleges that the interim final rule:
- Unlawfully narrows Congress’s protections for medically frail Medicaid recipients;
- Violates the Administrative Procedure Act by ignoring substantial evidence that work reporting requirements cause eligible individuals to lose healthcare coverage because of administrative barriers rather than a failure to work;
- Fails to adequately consider the significant harms that will be imposed on states, Medicaid beneficiaries, healthcare providers, and state healthcare systems; and
- Unconstitutionally coerces states by imposing new compliance requirements after states had already begun implementing the One Big Bill Act based on the statute’s plain language and CMS’s prior guidance.
In filing the lawsuit, Attorney General Brown was joined by the attorneys general of Arizona, California, Colorado, Connecticut, Delaware, the District of Columbia, Hawai‘i, Illinois, Maine, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Rhode Island, Vermont, Virginia, Washington, and Wisconsin, and the governors of Kentucky and Pennsylvania.
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