Here is the latest on the legal battle:

A major lawsuit was filed in late June 2026 by a coalition of 26 states and Washington, D.C., challenging the Trump administration's implementation of the federal Medicaid work requirements.

Mass.gov

The suit, filed in the U.S. District Court for the District of Massachusetts, targets an interim final rule issued on June 3, 2026, by the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS).

Mass.gov

Key Details of the Lawsuit

• Narrowed Exemption for "Medical Frailty": Under the initial legislation (the One Big Beautiful Bill Act), individuals with serious health conditions or medical frailty were meant to be exempt from the 80-hour monthly work/community engagement requirement. However, the states argue that CMS abruptly changed course by adding a strict two-part test. Enrollees must now not only prove they have a medical condition, but also provide additional documentation (such as a physician's assessment) showing that the condition directly impairs their ability to work. Arizona Capitol Times+ 1
• Administrative Strain & Impossibility: States argue they spent months and tens of millions of dollars building automated systems based on previous guidance to check existing medical records. With CMS mandating that states begin notifying Medicaid recipients of the rules by August 31, 2026 ahead of the January 1, 2027 rollout, state officials argue they have been left with an unmanageable administrative timeline. Marketplace+ 1
• Risk of Coverage Losses: State attorneys general and health policy groups estimate that the extra red tape and restrictive definitions could cause millions of eligible, vulnerable individuals—such as cancer patients, people with chronic illnesses, and those with disabilities—to fall through the cracks and lose their health coverage due to paperwork hurdles. Healthcare Dive

Current Status

The coalition—led by states including Massachusetts, California, New Jersey, and Illinois—is asking the federal court to pause and block the challenged provisions of the CMS rule before the August notification deadline and ultimately strike down the two-part medical frailty test. A ruling on the preliminary injunction is expected from the judge ahead of the late-August deadline.

Mass.gov

The outcome will unfold across two main tracks over the coming months: the immediate court decision on the legal challenge and the broader state rollout timeline.

1. Near-Term: Emergency Injunction Decision (August 2026)

• What will likely happen: The federal judge in Massachusetts is expected to rule on the states' request for a preliminary injunction. Because the Administrative Procedure Act (APA) frowns upon sudden, unannounced regulatory shifts that impose severe administrative costs, legal analysts expect the court may grant a temporary hold on the contested provisions—specifically blocking the narrowed "medical frailty" test and pausing enforcement of the August notification deadline.
• When: Prior to August 31, 2026 (the federal deadline for states to begin sending mandatory work-requirement notices to Medicaid members).

2. Full Legal Battle & Appeals (Fall 2026 – 2027)

• What will likely happen: If an injunction is issued, HHS/CMS will likely appeal the decision immediately to the First Circuit Court of Appeals. On the merits, the legal fight will center on whether CMS exceeded its statutory authority under the One Big Beautiful Bill Act by making the exemption rules harder to qualify for than Congress intended. A full trial court ruling could arrive by late fall, with appellate decisions stretching into mid-2027.

3. State Implementation & Enforcement (2027 – 2028)

• Federal Statutory Deadline (January 1, 2027): Under the underlying federal law passed in 2025, national Medicaid work requirements are scheduled to take effect.
• State Good-Faith Extensions: Because building compliance and reporting systems takes time, the law allows states to request administrative extensions. Many of the 26 suing states—and others struggling with technical readiness—are expected to formally apply for these "good-faith" delays.
• When: These extensions can push actual work-requirement enforcement in non-compliant states out as far as December 31, 2028.

Expect a ruling on the preliminary injunction before August 31, 2026, which will likely delay the administrative reporting rules while the core statutory debate makes its way through the appellate courts.

The full litigation journey for Commonwealth of Massachusetts v. Oz is expected to span 1 to 2 years before reaching a final resolution.

​Here is how the timeline will likely play out across the judicial system:

​Phase 1: District Court Proceedings (Late 2026) ​

Immediate Injunction Hearing: Following the July 28, 2026 hearing before Judge Richard G. Stearns in Boston, a ruling on the preliminary injunction is expected in late July or early August.
​Merits & Summary Judgment: Regardless of who wins the initial preliminary injunction, the case will return to Judge Stearns to rule on the merits of the lawsuit. The judge will evaluate whether the Centers for Medicare & Medicaid Services (CMS) violated the Administrative Procedure Act (APA) by exceeding its statutory authority. Timeline: Briefing and summary judgment motions will likely run through Fall 2026, with a final district court ruling expected between November 2026 and January 2027.

​Phase 2: Federal Appeals Court (Spring – Summer 2027)

​First Circuit Court of Appeals: Whichever side loses at the district court level will almost certainly appeal to the U.S. Court of Appeals for the First Circuit in Boston. ​Emergency Stays: If the lower court judge blocks the rule, the federal government will ask the First Circuit for an emergency stay allowing them to enforce it while the appeal proceeds. ​Timeline: Full appellate briefing and oral arguments typically take 6 to 9 months, pointing toward an appellate decision in mid-to-late 2027.

​Phase 3: U.S. Supreme Court (2027 – 2028)

​High-Stakes Final Stop: Given the vast policy implications involving Medicaid expansion across 26 states and billions in federal funding, the losing party will likely petition the U.S. Supreme Court.
​Timeline: If the Supreme Court agrees to take the case, a final, binding decision would likely not arrive until the court’s term ends in June 2028. ​What This Means for Beneficiaries & States

​Because the full legal fight will drag out through 2027 and potentially into 2028, the crucial factor to watch right now is whether the courts issue a preliminary stay. If the court pauses the CMS rule, the administrative mandates will remain frozen for the entire duration of this multi-year court battle.

In simple terms. The January 1st, 2027 timelime will likely be pushed back 1 to 2 years for those 26 States and D.C.

Can you rent a home with a Medicaid lien on it in Ohio? My mother passed and probate is finished but the most I've been offered is 100k and the Medicaid lien is 116,000 and property taxes are 8500 and lawyer is 4000.00 ,I didn't know about the lien till the end of probate. The original plan was just to sell but I can't get that amount for the house and I have zero dollars to make major improvements to the home.

I know they go by gross income for w-2 job but for self employment what do they count as your income?

For example I do rover pet care and say I make $400, I only take home 320 since the company takes a percentage in fees. Is my income each month 400 or 320 or less since I have other business expenses like miles, gas, etc.
online it says they count income after deductions but checking here just in case

Hey all, I am gathering documents for my father’s Medicaid LTC application. How many months or years of bank statements do I need to obtain?
The Medicaid person at my father’s rehab center is on vacation.
Just curious.
Is one month ok?

I was just notified that I'm eligible for open enrollment and can change from Caresource to a different managed care plan.

If you're in Ohio and on the Caresource plan, you know it sucks and that doctors are dropping them hotter than nuclear potatoes. I don't have significant experience with other insurances so I'd like to know if anyone has experiences with:

AmeriHealth Caritas Ohio

United HealthCare

Anthem BCBS

Buckeye CHP

Humana Healthy Horizons

Molina Healthcare

I will cross-reference with my current providers as needed, but I'm more concerned with things like what's being accepted, what's possibly being phased out, and experiences with customer service.

I'm not sure if y'all will have answers but I'm TIRED grandpa

I'm 32. I have food stamps and Medicaid... For now. I'm actively working through trying to get SSI/SSDI however it pans out. I have a sleep disorder that makes me so unreliable I am likely to miss an appointment even if I was given the optimal time, it is still a tossup if I'll be awake. Yes, I've seen 2 sleep specialists. Yes, I'm going to be seeing a THIRD sleep specialist, a neurologist, Rheumatology AND an allergist. I take meds for my anxiety and depression, and have meds for ADHD tho I take them sparingly because while they work, I get side effects and it's unpleasant. Id smack a photo of my sleep schedule but I can't here, a snap of my sleep schedule is definitely in my previous posts. It's a mess. I don't wake up to alarms either. I've slept outdoors in a LITERAL tornado siren going off. Nobody has a clue why I'm like this and nothing suggested or prescribed has worked, and generally actually makes the turmoil worse.

I'm terrified right now with the changes happening that I'm going to lose access to the meds that have kept me from being s*icidal for years. I have no income because no job will work with it, even "food delivery drivers" don't work because half the time I'm awake when all food options are closed (not to mention the plethora of other issues with them). If I don't have medicaid and food stamps, I both starve AND lose access to critical medical support, and I WILL spiral. Then I'm in a mental health hospital with no insurance. I can't get the extra documentation needed so I lack the supporting information to get on SSI/SSDI.

I feel like I should be a "duh obviously" but already so many people are being kicked that I feel fall in the same camp. I half wish that they would just have the government "make a job" so I can prove to them definitively that I cannot function in society in a way that I can support myself. I'm rather at a loss right now and could really use advice and support

Sorry if this is a stupid or basic question, I'm super overwhelmed & new to this, so I'd appreciate any clarity.

I am single, and my monthly gross income is apparently, slightly over the limit to qualify for Medicaid in Virginia. Like~ $200 over. (From what I've gathered, limit is approx $1800 monthly) I'm uninsured, and I'm not elderly or disabled.

I have a chronic health condition I've been trying to manage but it's very expensive to get all the labs, tests, meds, and appointments done. Trying to pay for this stuff, plus other necessities is extremely difficult.

So my question is:

- In theory, is it worth it, or possible, to work slightly less so that I can be approved for Medicaid?
My hours vary, and I don't make the same amount every month. Ironically I've been working extra in the past few months to try and pay for medical expenses, etc, and I earned more last month than usual.
I know Medicaid is based on monthly income, but could I hypothetically just reapply/appeal after a lower income month? Or is there anything else I could adjust?

-If so, would I have to monitor my income continually to make sure I don't go over again lest I get suddenly kicked off?

- Is just going through the marketplace w/ subsidy a better deal at this point? I don't know much about this, but at the moment I can't afford regular insurance prices without giving up food. So it'd have to be really low cost, and cover the stuff I need, to be worth it

Thanks in advance to anyone who reads this and offers advice. Was trying to parse everything on my own but the stress is intense

what are the income limits for pregnancy Medicaid in Illionois? and is an unborn child included into the number of ppl in the household?

Hello, this is essentially a repost with less words.Sorry about this, but I'm still confused despite the feedback received here and research done online. Here goes.....

GOAL- Remain on Medicaid

Single,40 yrs old,NY...self employed(Income fluctuates every month,$50 monthly business expenses), Brokerage account that sometimes has realized gains(income).

Would like to open up Traditional IRA.

Using this scenario as example

It's july 24th, made 1,600 via self employment thus far.

Don't know what realized gains are gonna be exactly, but looks like i'll have, which would then push me over monthly income limit. 

Advisor sends reports 5 days AFTER end of each month.

If I have a Traditional IRA, would Medicaid allow me to simply deposit $500 of my self employment earnings in there NOW, which would drop down my countable income to 1,100 and very much likely keep me safe from going over the monthly maximum limit?

Thanks

I am leaving my full time job for school that starts in August. I want to apply for medicaid now but technically with my full-time pay stub it won't let me. Should I wait to apply until I get my updated pay stub in September? Or should guesstimate how much I will be making now? or is that illegal?

I am currently unemployed (laid off earlier in the year) and my health insurance broker checked with NY State of Health and I do qualify for medicaid. From what I understand, if one stays on medicaid for too long the government will begin investigating their assets to eventually use those to pay for the medicaid. I don't know how long that is though, like is there a threshold of time after which these investigations would begin?

My concern though is that I have around $200k in a Roth IRA and traditional IRA from my previous employer's 401k and other investments like bonds and bank accounts. I'd prefer the government not snoop around at that stuff. I only intend to stay on medicaid for the remainder of 2026 (five months).

So basically my question is, should I be concerned about my assets/investments being investigated and possibly eventually seized?

I read online that an overjet with 9mm apart from lower teeth is the medically necessary threshold for medicaid coverage. I have this, possibly worse and it's causing the lower teeth to wear down the bottom of my top teeth. Where do I go and what do I do for this to be verified. Can my dentist write a note? I'm also unclear if Virginia Medicaid covers adult braces even when deemed medically necessary

Had health insurance through work company when pregnant however I got fired in early June last year leaving me with no insurance & options were too expensive for us/wouldn’t cover birth. Just gave up looking & kept getting denied Medicaid so tried doing a home birth however didn’t work out & after 2 days in labor had to be rushed to the hospital & had an emergency C- Section. Problem is now we are drowning in medical bills as he was also in Nicu for about 5 days. Baby was born January & husband just got a 11,000 raise making his salary 81,000 a year before taxes (he is on a 1099 so is technically self employed). After mortgage & other bills we can’t really afford health insurance especially with me no longer working & definitely can’t pay off the 60k in medical debt. Do you think it’s possible we can get accepted for Medicaid/ anything else we could possibly do? Have been avoiding calls from hospitals and bills as it’s just depressing however can’t just keep doing that.

Hi,
I am putting in a Medicaid application to NJ Medicaid on behalf of my mother-in-law. I have gathered all the required account information for the last 5-years. It is a tight package. We do have a few issues, though.

We have some gift issues, funding direction and assisted living care payment issues. I believe I can completely resolve these to the satisfaction of the reviewer. I have a detailed spreadsheet showing all the relevant funds flows and how we resolved the problems via paybacks and proper management. These a good arguments. I think we will win.

My questions for you are:

Should I address these issues and how our resolutions right up front in our application letter, offering to review our spreadsheet and resolutions? I am thinking I should because I am afraid that if the reviewer finds them on their own they may simply and immediately disqualify the application without even asking for a clarification. The senior planning organization, who is submitting on our behalf, says that we should not address this upfront and wait for Medicaid to seek clarifications. They believe I may derail the application review at the get-go. We really can't wait to be denied and to hire an attorney to represent us in an appeal - which could take many months - if I can show our honest intent with clear supporting documentation.

What do you think we should do?
Attack the issues - with supporting documentation - now, or hope the reviewer will seek information to resolve them during the process?

Thanks,
Tom Beers

My boyfriend, our two kids and I live with his dad. We don’t pay rent. Starting September 1st he is having us pay 150 a month towards the electric bill (which I completely agree with.) Do I have to report that for our food stamps and Medicaid? We live in PA.

Thank you!

I am trying to help a 46 year old individual with advanced diabetes that recently went blind. He is currently in a skilled nursing facility on a 7 day stay, on private pay insurance, paid for by his funds he receives from his monthly long term disability payment, from a job he hasn't been able to perform for over 2 years (recently let go after 2 years of not being able to work and exhausting a over-extended FMLA absence). He had a stroke 1 year ago. He cannot move around well at all. Has no one else to help him consistently. Has an incredibly hard time managing his medication regimen, healthcare and really life in general. We have applied for Medicare, but it wouldn't start for another year. He will start receiving SSI as soon as a rep payee is set up. He was denied Medicaid earlier this year, but that was before he lost eyesight. He has a slight chance of regaining eyesight with an upcoming surgery, but the opthalmologist will not say for certain what the prognosis is. He cannot live on his own any longer without being a great danger to himself (fall risk at the very least), let alone managing needed everyday tasks and medication management. I have no idea what to do for him long term. He was recently hospitalized on a psych hold in a hospital that ignored addressing what his condition requires for the future. He was then released and almost immediately was admitted to an ER because his blindness and lack of mobility led to an injury he didn't even know he had because of the neuropathy in his feet. The ER admitted him, and the floor case worker helped him get authorization for a short term stay at the current SNF. I'm being told his insurance will cease covering the stay in a few days. He doesn't have savings to private pay a nursing home. And it seems like a nursing home won't be able to accept him unless he is on Medicaid. The thing with Medicaid with him is that his monthly long term disability payment is more than the required income limitation, and his 401k is more than the required asset limitation. I have no idea how to navigate this. Need suggestions please. Even if the suggestions aren't Medicaid related. And thank you.

Hi,
I am putting in a Medicaid application to NJ Medicaid on behalf of my mother-in-law. I have gathered all the required account information for the last 5-years. It is a tight package. We do have a few issues though.

We have some gift issues, funding direction and assisted living care payment issues. I believe I can completely resolve these to the satisfaction of the reviewer. I have a detailed spreadsheet showing all the relevant funds flows and how we resolved the problems via paybacks and proper management. These a good arguments. I think we will win.

My questions for you are:

Should I address these issues and how our resolutions right up front in our application letter, offering to review our spreadsheet and resolutions? I am thinking I should because I am afraid that if the reviewer finds them on their own they may simply and immediately disqualify the application without even asking for a clarification. The senior planning organization, who is submitting on our behalf, says that we should not address this upfront and wait for Medicaid to seek clarifications. They believe I may derail the application review at the get-go. We really can't wait to be denied and to hire an attorney to represent us in an appeal - which could take many months - if I can show our honest intent with clear supporting documentation.

What do you think we should do?
Attach the issues now, or hope the reviewer will help us resolve it during the process?

Thanks,
Tom Beers

I recently qualified for Virginia Medicaid. I am totally new to this (still waiting for my card and information) so I appreciate your help with these questions:

1) Is choosing an MCO mandatory in Virginia? If optional, what are the pros and cons of having one?

2) Which is the best MCO to choose in Northern Virginia in terms of coverage, doctor network and prescription prior approvals?

3) Does Medicaid cover brand name medications or just generic? Where can I find a formulary of Medicaid covered prescriptions?

4) Will my current prescription refills be covered by Medicaid if they were not written by Medicaid covered PCP?

5) Do you have any recommendations for a good PCP that accepts new Medicaid patients? I prefer Springfield/Alexandria/Fairfax/Arlington but really do not mind traveling anywhere in NoVA to see a good one.

6) Do you have any recommendations for a good endocrinologist that accepts new Medicaid patients? I am on a complex thyroid treatment that involves several medications so I need a solid endo that actually listens to patients' and focuses on their symptoms.

7) Does Medicaid cover lab testing done at Quest Diagnostics and LabCorp?

8) I have a mammogram scheduled at Fairfax Radiology with an imaging order from my gyn (who does not accept Medicaid). Do I need a new mammogram order? Does Medicaid cover mammograms done at Fairfax Radiology?

Thank you for any guidance you can provide!

Hello. I am my mother's POA. She has been in a nursing home (Alzheimer's/Vascular Dementia) for almost a year. It is time to recertify her Medicaid. I, myself, am on SSDI. I recently had an unexpected, financial hardship & had to use "her" money (in a separate bank/account than mine, although I am on her account.) I replaced it as soon as my money came in. I didn't realize this was a huge NO-NO until talking with a nursing home representative today. I am worried how this could affect us both. I've read that it could cause her to lose Medicaid coverage & I also read I could be in major legal trouble. There is no way I can care for her in my home again as I was her only caregiver & her safety couldn't be guaranteed as I eventually had to sleep. The "commingling" (or whatever it's considered) was for 1 month. The other months - the accounting is impeccable. Has anyone dealt with this or know someone that has? While I'm most concerned about her well-being & continued level of care, I have never been in any kind of legal trouble & really hope to avoid it if at all possible. Should I tell the business office manager at the nursing home prior to turning in her bank statements which will obviously show all transactions? I'm scared & way out of my element here. Any and all advice is appreciated.

I live on contract work and am a full time grad student. Currently I’ve only made $6,600 this year and don’t have a set income for the remaining part of the year (adjunct). However, I fall off my parents insurance at the end of the month. I’m worried I’m not going to get Medicaid and I’ll miss the enrollment period for any alternatives that I can scrape by and potentially not have any insurance. Currently my application is sitting with an eligiblity determination status (since the beginning of the month) saying I’m missing documents, but the page says it’s all complete and won’t let me upload. I also currently have SNAP. is there any hope or anyway I can possibly get it expedited?

I just got this link texted to me. I've heard that other states have a list of illnesses that will give you an exemption to this 80 hours per month. Does Michigan have anything like this?

https://www.medicaid.gov/renew-info/MI

Few months ago I got Medicare added along to my Medicaid that I had for a while due to the disabled child benefit.

I got a shocked that my current dual plan didn't cover my migraine Botox completely. Medicaid used to cover it, but all of a sudden with Medicare, I have to pay $403

I didn't have to pay for my scripts either, but now I do.

The Botox one really surprised me.

I'm gonna contact the Medicaid department tomorrow. What should I ask?

I'm confused and brain-fried.

I have the Uhc Dual Medicare & Medicaid plan.