A federal judge on Thursday declined a request by more than two dozen Democratic-led states to block a Trump administration policy that would require Medicaid recipients with terminal illnesses to prove they are too sick to work in order to be exempt from new work requirements set to take effect in January.

The policy, announced last month, stems from the prior year's sweeping Republican tax and budget legislation. While that bill introduced over $1 trillion in tax cuts for the wealthiest 1% of Americans, it simultaneously imposed new 80-hour-per-month work requirements on states for Medicaid expansion recipients — individuals who receive government-subsidized insurance coverage at or below 138% of the federal poverty line. Medicaid expansion, adopted by 40 states and the District of Columbia under the Affordable Care Act, currently provides coverage to approximately 20 million low-income adults.

The legislation stipulated that individuals who are "medinally frail or otherwise have special medical needs" would be excluded from the work requirement, specifically citing those with a "serious or complex medical condition." However, the precise conditions qualifying for exemption remained ambiguous.

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) issued a new rule clarifying that even individuals diagnosed with terminal diseases such as cancer, HIV/AIDS, or Parkinson's would not automatically qualify for an exemption. Beginning January 1, 2028, these individuals must also demonstrate to their respective states that their condition "significantly impairs" their ability to satisfy the work requirement.

Democratic attorneys general from 25 states and the District of Columbia filed a preliminary injunction late last month, contending that CMS had effectively rewritten the law by introducing a vague and excessively restrictive hurdle for vulnerable individuals seeking essential medical care. The challenge follows an earlier round of litigation during Trump's first term, when federal courts struck down Medicaid work requirements approved for several states — including Arkansas, where an estimated 18,000 people lost coverage before the rules were halted.

"This is one of those cases where it's really hard to overstate how dire the consequences could be," North Carolina's Democratic Attorney General Jeff Jackson told Politico. "You're going to have 50 states doing 50 different things, and we're all going to have to create a whole new bureaucracy... You are talking about a lot more paperwork, more evaluations, more doctor visits, and a lot more work for doctors themselves."

The Democratic AGs further argued that implementation should be paused because states lacked the staff or administrative capacity to meet the timeline CMS established, which requires states to notify enrollees about how they will be affected by the changes by the end of August.

US District Judge Richard Stearns, a Clinton appointee sitting in the District of Massachusetts, denied the request to immediately halt implementation while the lawsuit proceeds. However, Stearns did not rule on the lawsuit's merits, which are scheduled to be decided before the requirements go into effect on January 1.

Several major medical associations have publicly opposed the rule, including the American Medical Association, the American College of Physicians, and the American Academy of Pediatrics, arguing it would have severe consequences for individuals suffering from serious illness.

"One of the most significant factors in whether someone survives a cancer diagnosis is whether they have health insurance coverage," Lisa Lacasse, president of the American Cancer Society Cancer Action Network, explained in June.

"The new restrictions link the definition of medical frailty to a person's ability to work," Lacasse continued. "This would mean cancer patients and survivors who are suffering from debilitating side effects of the disease or treatment would have to officially prove they can't work, in a process that is likely to be difficult and take a long time."

The nonpartisan Congressional Budget Office has projected that over the coming decade, healthcare policy changes introduced by Republicans would increase the number of uninsured Americans by approximately 11.8 million. Of those, an estimated 5.7 million are projected to be Medicaid recipients who either fail to meet the 80-hour work requirement or are otherwise eligible but obstructed by newly imposed paperwork requirements.

Writing earlier this week for The Real News Network, Taya Graham and Stephen Janis argued that eligible individuals losing coverage is not an unintended consequence of the law but rather a deliberate objective of the Republicans who passed it — a mechanism to reduce the number of Medicaid-qualified individuals without undertaking the politically unpopular step of directly cutting benefits.

They pointed to the Supplemental Nutrition Assistance Program (SNAP) as an illustration of how burdensome such requirements can become. As The New York Times reported earlier this month, Arizona has already removed 440,000 people from SNAP after implementing an onerous paperwork regime requiring low-income recipients to prove eligibility — including demanding that some individuals with panhandling income obtain documentation from donors who give them money on the street.

"If this is what people receiving SNAP benefits have been subjected to," Graham and Janis wrote, "imagine what's going to happen to people who will need to navigate the new [Medicaid] requirements while struggling with a debilitating or terminal illness."

Medical issues remain a leading cause of bankruptcy in the United States. According to one study, over four in ten cancer patients aged 50 and older had depleted all of their assets within two years of diagnosis.

Melanie D'Arrigo, a single-payer healthcare advocate based in New York, stated on X that President Donald Trump "cut cancer research, cut healthcare," and through the new Medicaid restrictions "wants to make sure Americans continue to work as they go broke battling cancer."