Court fight over Medicaid work rules hinges on who’s too sick to work

Democratic attorneys general and the Justice Department are challenging a Trump-era rule that would require Medicaid expansion adults to work 80 hours a month, arguing that a cancer diagnosis or other illnesses aren’t enough to exempt someone and that the rule is too vague on how to judge medical frailty. The Boston court ruling could determine who must work, volunteer, or study to keep coverage and how states verify exemptions, amid a rocky rollout (notably Nebraska) and concerns about administrative burden. The policy aims to curb costs ahead of the 2027-2028 rollout and becomes a focal point in the broader political fight over Obamacare’s Medicaid expansion.