Washington, Minnesota, New Mexico and Oregon sued the Trump administration on Nov. 5, arguing that the new federal Medicaid work rules go beyond what the Constitution allows. Washington Attorney General Nick Brown, who filed the case with his counterparts, says the state’s own Health Care Authority expects about 120,000 Washingtonians could lose coverage. That figure is Washington’s estimate for Washington alone, not a count across the four states.
The complaint was filed in U.S. District Court in Eugene, Oregon, and names the federal Department of Health and Human Services. It targets the requirement, written into the 2025 budget law known as H.R. 1, that adults covered through Medicaid expansion regularly prove they are working, in school or volunteering. Implementation does not begin until 2027, so anyone covered today still has coverage while the case moves.
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Where does the 120,000 come from?
More than 600,000 Washington residents are enrolled in Apple Health, the state’s name for Medicaid, through the Affordable Care Act expansion, and those are the people the work rule would reach. The Health Care Authority estimates that at least 20 percent of them could lose coverage, which the attorney general’s office rounds to about 120,000 people. Apple Health as a whole covers more than 1.9 million residents.
The state says the damage would not stay with enrollees. Brown’s office expects the rules to hit rural counties hardest and warns that rural health facilities could close if the coverage losses materialize. He called the rules “the latest cruel effort to shred the safety net” and said the red tape will make people “stop going to the doctor when they’re sick.”
What are the four states actually arguing?
The Nov. 5 complaint takes a different route than the lawsuit 25 Democratic-led states filed earlier. That June 29 suit challenged specific provisions of an interim final rule HHS and the Centers for Medicare & Medicaid Services published June 3, including a narrower reading of who counts as medically frail. The newer filing instead argues that Congress and the federal administration exceeded their constitutional authority by requiring Washington to carry out the changes at all.
Brown’s office says he has already blocked the paperwork requirements for seriously ill Washington residents in an earlier action. The release does not say when a judge will take up the new complaint, and no ruling has been announced.
Why did the states go back to court?
The earlier coalition argued that the June rule ignores evidence that reporting requirements cost people coverage because of administrative barriers rather than because they are not working. It also said the rule fails to weigh the harms to states, patients and hospitals, and that it coerces states by adding requirements after they had begun carrying out the law as written. States were told to begin notifying Medicaid members of the changes by Aug. 31, 2026.
The newer case goes after the foundation rather than the rule’s details. The attorney general’s release says the complaint argues Congress and the administration overstepped, and it does not describe a hearing date.
Who would the rule reach, and who is exempt?
The federal rule applies to adults ages 19 to 64 who gained coverage through expansion. Louisiana’s Medicaid agency, summarizing the federal requirements, says those members must earn at least $580 a month or complete 80 hours a month of work, a work program, volunteering, community service or school, starting Jan. 1, 2027. A mix of activities counts if the hours total 80 in the same month.
The same summary lists the people who are exempt. They include people who are blind or disabled, medically frail, veterans with a total disability rating, pregnant or postpartum, parents or guardians of a child under 14, caregivers of a person with a disability, people in substance use treatment, and people already meeting SNAP work requirements. People who are 65 or older, or enrolled in or entitled to Medicare Part A or B, are also exempt, which keeps most retirees outside the rule.
What happens to someone who misses the paperwork?
State Medicaid offices will first try to confirm work and income from data they already hold, such as employment and Social Security records, according to Louisiana’s summary. If that fails, they mail a letter asking for proof. The agency warns that not responding can mean losing coverage even when a person is still eligible, and that renewal packets go out 60 days before the renewal date with 45 days to answer.
A person who loses coverage for missing the requirement can reapply after working for one month and has the right to appeal. Louisiana adds that most adults 19 to 64 will have one month of possible retroactive coverage starting in 2027, down from three, and that people can report online, by mail, by fax, by email or in person. Those details come from Louisiana, so the exact notices, forms and deadlines in Washington, Minnesota, New Mexico or Oregon may differ. For anyone in those four states, the state Medicaid agency’s notice is the free place to confirm which category applies.
Will an Apple Health or Medicaid notice find the right category for you in 2027?
A lawsuit does not stop the notices. Until a court says otherwise, expansion adults ages 19 to 64 in Washington, Minnesota, New Mexico and Oregon still face the Jan. 1, 2027 start, and a missed letter is how coverage gets lost even by people who qualify for an exemption.
The SNAP & Medicaid Renewal Organizer explains the new Medicaid work requirement and who is exempt. The 20-page organizer also includes a state pack for each state, plus a renewal document checklist and a renewal and reporting calendar so no date slips.
Get the Medicaid work-rule guide and exemption list before the 2027 start →
This article was produced with AI assistance and edited for accuracy against the sources linked above.
David M. Keller is a finance writer based in Columbus, Ohio, covering personal finance and consumer-focused economic topics. He earned his degree in journalism from Ohio University and began his career reporting on local business and economic trends for a regional media outlet. Since then, he has contributed to a variety of online publications, focusing on clear, practical coverage of topics such as cost of living, debt, and everyday financial decision-making.
