Public Health Leaders and 169 Scholars File Amicus Brief Challenging CMS Medicaid Work Requirement Rule

FOR IMMEDIATE RELEASE
Contact: [email protected], [email protected]

The American Public Health Association, Grantmakers in Health, the George Washington University Milken Institute School of Public Health’s Jacobs Institute of Women’s Health and National Center for Medical-Legal Partnership, Liberty Health Alliance and 161 public health and health policy deans, chairs and scholars have filed an amicus curiae brief supporting a challenge to a federal Medicaid rule they argue unlawfully narrows protections for people with serious health conditions.

The brief supports the 26 states challenging the Centers for Medicare & Medicaid Services’ (CMS) interim final rule implementing Medicaid “community engagement” requirements in the lawsuit Massachusetts v. Oz.

Under legislation enacted by Congress in 2025, certain Medicaid enrollees must complete at least 80 hours per month of work, community service or education to enroll or maintain eligibility. Congress created an exclusion for people who are medically frail or have special medical needs, including people with serious or complex medical conditions, certain disabilities, substance use disorders and disabling mental health conditions.

The amici argue that CMS went beyond Congress’s intent by requiring people with qualifying health conditions to also prove that their condition “significantly impairs” their ability to meet the 80-hour requirement. The rule also limits the evidence states can use to determine whether someone qualifies for the medical frailty exclusion.

“This damaging rule is administrative overreach that will result in the loss of health coverage for millions of Americans,” said Georges C. Benjamin, CEO of the American Public Health Association. “It will disproportionately harm those most at risk, including those with chronic and complex medical conditions. The administration should revoke this rule, and any revised rule must adhere to Congressional intent to honor the exclusions from the community engagement requirements explicitly mandated in the text of H.R. 1.”

The brief argues that additional documentation and reporting requirements could create significant barriers for people with serious health conditions and lead eligible individuals to lose coverage. The amici also point to evidence from previous Medicaid work requirement experiments in Arkansas and Georgia that found substantial coverage losses without measurable increases in workforce participation.

“CMS’s rule is arbitrary and capricious because it ignores –  and in important respects contradicts – a wealth of evidence, including CMS’s own data and research, showing that these requirements will lead to significant Medicaid coverage losses and harmful health impacts for people with serious health conditions, the very population that Congress intended to protect,” said Alison Barkoff, Hirsh Health Law and Policy Associate Professor and Program Director at the George Washington University Milken Institute School of Public Health.

The brief also warns that coverage losses could increase uncompensated care and administrative costs for hospitals, community health centers and other safety-net providers, particularly in underserved and rural communities.

“The health and health care consequences of the administration’s medical frailty rule, if allowed to proceed, could not be more serious for health care providers struggling to meet the need for care in medically underserved communities nationwide,” said Sara Rosenbaum, Liberty Health Alliance board chair.

The amici ask the U.S. District Court for the District of Massachusetts to grant the plaintiffs’ motion for summary judgment and vacate the challenged portions of the CMS rule.

• The brief can be found here.
• This filing is part of the Hirsh Health Law and Policy Program’s Health Scholars Legal Initiative
• Amici are represented by Ropes & Gray LLP.

The views presented in the brief represent those of the amici and do not necessarily reflect the views of their institutions.

###

The American Public Health Association champions optimal, equitable health and well-being for all. With our broad-based member community and 150-year perspective, we influence federal policy to improve the public’s health. Learn more at www.apha.org.