Five states pen an open letter, pleading with HHS, RFK to delay Medicaid work requirements
Five states have formally asked the U.S. Department of Health and Human Services (HHS) to delay the enforcement of Medicaid work requirements, citing their inability to develop the protocols and systems needed to ensure compliance by the Jan. 1 deadline.
In a letter addressed to HHS Secretary Robert F. Kennedy Jr., the governors of California, Maine, New Mexico, Oregon and Virginia argue that guidance from the Centers for Medicare & Medicaid Services (CMS), issued as interim final rule over the summer, “introduced significant changes from the direction CMS had communicated to states over the preceding year,” creating a situation that potentially negated any pre-planning.
Citing an early letter states sent in May 2026, they noted there were only “two straightforward requests” state health departments would make in ensuring they can comply with federal law, the first being that any rule from CMS “align as closely as possible with operational assumptions states had reasonably developed” when they began preparing for the logistical challenges of complying with new Medicaid eligibility criteria, which passed in summer 2025 as part of the One Big Beautiful Bill Act.
Second, they asked that they be given a “realistic timeframe to ‘make the changes necessary’ to audit Medicaid beneficiaries to ensure they are meeting minimum work and education standards for eligibility, or that they are “medically frail” enough to receive an exemption.
That issue of how “medically frail” is defined has been a major sticking point for states, with a lawsuit filed by 26 of them citing the problems with arbitrarily defining such a condition when it asked a federal court to issue an injunction. That filing stalled in July when a judge dismissed the case.
With the lawsuit stalled, a letter pleading their case to Kennedy and HHS may be the only recourse states have left to delay the enforcement and align with the expectations of CMS, which is asking for both a system to ensure work requirements are being met and one that proves a patient is medically frail.
“These are not minor or technical adjustments. They fundamentally change the processes and system logic underlying states’ implementation plans,” the letter reads. “With less than 100 days remaining before January 1, states cannot reasonably rebuild, test, and validate these systems while ensuring accurate notices, properly trained workers, and reliable, lawful coverage determinations.”
“We do not have sufficient time to make these changes responsibly before states must begin making consequential coverage determinations affecting millions of Medicaid enrollees.”
Millions could lose coverage
At the center of concerns over the balance of work requirements and definitions of medically frail is the only source of health insurance for millions of low-income and ill patients in state Medicaid programs.
As the states mention in both their letter and the lawsuit, many residents could be kicked off insurance they are otherwise eligible for under federal law, because documenting work, school hours, and medical frailty presents a unique set of challenges.
For example, if a worker loses their job, they could be kicked off Medicaid, only to have to go through the process of re-enrollment, including a new assessment of eligibility verification. For millions of Americans who change jobs regularly in the gig economy, this could mean multiple lapses in coverage a year.
On the other hand, some patients may be too sick to work or volunteer, but proving it can be difficult because of bureaucratic hurdles. This is a point Oregon Gov. Tina Kotek emphasizes in a statement her office released, drawing public attention to the letter.
“One-third of Oregon families—including seniors, disabled Oregonians and children—rely on Medicaid, which is the Oregon Health Plan. We're working to ensure people who are eligible have a pathway to stay insured,” she said. “The new rules institute additional administrative barriers that will lead to people losing their healthcare. That is why we are proactively getting information out to families and providers now and rapidly training eligibility workers as we coordinate our response to the changes across the state.”
HHS has not responded to the letter. For now, the Jan. 1 deadline for full compliance remains in effect.
While the true number of Americans who will be impacted by the new policy remains unclear, a recent estimate from the Urban Institute, a liberal thinktank, found that 2.3 million young adults, aged 19 to 24, could lose their Medicaid benefits by 2028.
The full text of the correspondence can be found by clicking here.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.