A federal judge has denied a request for a preliminary injunction by 25 states, including Washington, to pause the implementation of new Medicaid work requirements scheduled to take effect on Jan. 1. The ruling, issued Wednesday by U.S. District Judge Richard Stearns, means states must proceed with mandates established under the One Big Beautiful Bill Act while the legal challenge continues.

The federal law requires the 42 states that expanded Medicaid to mandate that adult recipients work, attend school, or volunteer for at least 80 hours per month to maintain their health coverage. According to reporting by the Washington State Standard, the Urban Institute has estimated that between 3 million and 7 million people nationwide could lose coverage due to these requirements. With the addition of more frequent eligibility checks, that figure could rise to 10 million over the next decade.

Washington is part of a coalition of states challenging guidance from the Center for Medicare and Medicaid Services (CMS) that narrowed the definition of “medically frail.” This designation allows individuals with serious illnesses or disabilities to be excused from the work mandates. The plaintiff states, which filed suit on June 29, argued the new definition is too narrow and would force vulnerable patients to navigate difficult administrative hurdles to keep their insurance.

In his ruling, Judge Stearns noted that the Jan. 1 deadline was set by Congress rather than federal agencies. He also addressed state concerns regarding the financial burden of implementation, pointing out that CMS has committed to reimbursing 90% of the costs for designing and installing the necessary eligibility systems. Stearns wrote that the states failed to show that the remaining 10% of costs would cause irreparable harm, stating that “injunctive relief is the exception, not the rule.”

While the judge allowed the implementation to proceed, the court acknowledged the case raises questions regarding the scope of authority delegated to the Department of Health and Human Services and CMS Administrator Dr. Mehmet Oz’s adherence to congressional intent. The lawsuit was brought by a coalition of governors and attorneys general from states including Oregon, California, and Washington.