【中美创新时报2026年6月30日编译讯】（记者温友平编译）包括马萨诸塞州、康涅狄格州、缅因州、罗德岛州和佛蒙特州在内的25个州提起诉讼，称本月发布的联邦指导方针为有资格享受医疗补助的人们制造了不公平的官僚主义迷宫。新规也给那些试图在1月1日截止日期前落实这些要求的州带来了混乱。《波士顿环球报》记者杰森·劳克林对此作了下述报道。
马萨诸塞州是周一提起诉讼的牵头州之一，该诉讼旨在阻止对医疗补助计划参保人的工作要求，预计这些要求将导致该州数十万人失去医疗保险。
包括康涅狄格州、缅因州、罗德岛州和佛蒙特州在内的25个州提起诉讼，称本月发布的联邦指导方针为有资格享受医疗补助的人们制造了不公平的官僚主义迷宫。新规也给那些试图在1月1日截止日期前落实这些要求的州带来了混乱。
新规要求大多数 19 至 64 岁的医疗补助受益人证明他们每月至少工作、上学或做志愿者 80 小时。
“特朗普政府试图对医疗补助计划受益人施加新的、繁重的要求，这威胁到我们最弱势的居民和家庭获得医疗保健的机会，”司法部长安德里亚·乔伊·坎贝尔周一在一份声明中表示。
在美国地方法院提起的诉讼中，被告包括卫生与公众服务部部长小罗伯特·F·肯尼迪和美国医疗保险和医疗补助服务中心主任穆罕默德·奥兹博士。
马萨诸塞州卫生部门领导人紧急采取措施，防止30万人失去医疗补助（Medicaid）资格。
美国医疗保险和医疗补助服务中心（CMS）和美国卫生与公众服务部（HHS）均未回复置评请求。
该诉讼的核心在于美国医疗保险和医疗补助服务中心（CMS）6月初发布的指导方针，该方针详细规定了哪些人可以豁免工作要求，而诉讼称这些方针与各州此前被告知的预期截然相反。具体而言，诉讼指出，对于体弱多病、患有严重慢性疾病且可能影响其工作能力的人，豁免标准附加了一些限制，这些限制与法律相抵触。法律明确规定，应无条件地向被认定为体弱多病的人授予豁免。
各州几个月来一直焦急地等待着这些指导方针。官员们表示，为了在年底前达到新的截止日期，马萨诸塞州需要招聘和培训新员工，并进行成本高昂的技术升级，同时仍在等待 联邦政府提供具体细节才能继续推进。
最受期待的细节之一是关于医疗虚弱豁免的具体规定。
诉讼文件显示，几个月来，美国医疗保险和医疗补助服务中心（CMS）多次发布初步通知，表明体弱豁免条款将与CMS之前的定义类似。诉讼文件还指出，各州根据这些信息制定了工作要求方面的准备工作。
然而到了5月份，CMS暗示豁免政策可能会变得更加复杂，并告知各州忽略几天前发布的信息。5月29日，马萨诸塞州医疗补助计划（MassHealth）前主任迈克·莱文致信CMS官员，警告称最终指南与预期大相径庭，可能会给该州带来严重问题。
美国医疗保险和医疗补助服务中心（CMS）发布指导方针后，其结果令各州医疗补助计划（Medicaid）的管理人员感到震惊。CMS指出，仅凭医疗虚弱程度不足以获得豁免。该机构还表示，当事人必须证明其病情已严重到无法工作。
专家表示，这样的标准会给参保人、医生以及麻州医疗补助计划（MassHealth）本身带来巨大的行政负担。他们还指出，这个标准令人困惑，因为许多疾病，例如精神疾病，即使不是完全不可能，也很难用一种能够明确判断一个人是否能够维持就业的方式来衡量。
在诉讼附件的一份声明中，麻州医疗补助计划（MassHealth）现任主任瑞安·施瓦茨博士写道，在最终指导方针发布之前，该州估计，工作要求可能会导致2014年通过医疗补助计划扩容而获得医疗补助的27万人中，多达一半的人在某个时候失去医保。他表示，最终指导方针表明，这个数字很可能被低估了。
他写道：“MassHealth 预计，更多符合资格的成员将被取消资格，仅仅是因为他们无法证明自己符合资格。”
马萨诸塞州官员表示，工作要求、资格审查的增加以及奥巴马医改保险市场的变化预计将导致该州约 30 万人失去医保。
各州现在面临着8月31日的最后期限，必须向医疗补助计划（Medicaid）受益人提供关于工作要求具体实施方案的详细信息。诉讼指出，这些指导方针迫使医疗补助计划管理人员仓促应对这些意料之外的变化，从而造成了当前的损害。
“这起诉讼很有实质内容，”波士顿大学卫生法教授妮可·胡伯菲尔德 (Nicole Huberfeld) 谈到这起诉讼时说。
她表示，尽管医疗补助改革十分复杂，存在出错的风险，而且偏离了原法律的措辞，但指导方针的突然转变，使得这场诉讼成为对政府的合理挑战。
哈佛大学陈曾熙公共卫生学院卫生政策与政治学助理教授阿德里安娜·麦金泰尔也认为，这起诉讼提出了合理的质疑，即法律条文与政府实际执行法律之间存在差距。她表示，目前这起诉讼面临的主要障碍可能仅仅是时机问题。
“这项规定尚未生效，”她说。“问题在于，法院认为这些损害在多大程度上是假设性的，还是各州目前正在遭受损害？”
题图：马萨诸塞州总检察长安德里亚·坎贝尔是发起诉讼的领导者之一，该诉讼旨在阻止对医疗补助计划受益人实施工作要求。约翰·图卢马基/波士顿环球报
附原英文报道：
Five New England states, including Massachusetts, sue to block Medicaid work requirement
By Jason Laughlin Globe Staff,Updated June 29, 2026, 7:38 p.m.
Attorney General Andrea Campbell is among the leaders of a lawsuit to block work requirements for Medicaid recipients. John Tlumacki/Boston Globe
Massachusetts is among the leaders of a suit filed Monday to block work requirements for Medicaid enrollees that are expected to cost hundreds of thousands of people in the state their health insurance.
The suit filed by 25 states, including Connecticut, Maine, Rhode Island, and Vermont, contends federal guidelines released this month create an unfair bureaucratic maze for people entitled to receive Medicaid coverage. The new rules are also causing turmoil in states trying to meet a Jan. 1 deadline to implement the requirements.
The new rules require most Medicaid recipients between the ages of 19 and 64 to prove they work, attend school, or volunteer at least 80 hours a month.
“The Trump Administration’s attempt to impose new, burdensome requirements on Medicaid recipients threatens access to healthcare for our most vulnerable residents and families,” Attorney General Andrea Joy Campbell said in a statement Monday.
Among the named defendants in the suit filed in US District Court are Secretary of Health and Human Services Robert F. Kennedy Jr. and Dr. Mehmet Oz, director of the US Centers for Medicare & Medicaid Services.
Thousands drop health insurance in Mass., and picture is expected to get worse, experts say
Massachusetts health leaders scramble to prevent 300,000 from losing Medicaid coverage
Neither CMS nor HHS replied to requests for comment.
The lawsuit centers on guidelines CMS issued at the beginning of June that included details on who could be exempted from the work requirements, and which the suit says were an about-face from what states had been led to expect. Specifically, the suit states the standards for an exemption for people with medical frailty, people with serious, chronic health problems that could hinder their ability to work, adds restrictions that contradicted the law, which simply says exemptions should be granted to people deemed medically frail without conditions.
States had been anxiously awaiting these guidelines for months. To meet the new deadlines by the end of the year, Massachusetts needed to hire and train new staff and implement costly tech upgrades, officials said, while still awaiting specifics from federal authorities to move forward.
Among the most anticipated details were specifics about the medical frailty exemption.
For months, according to the lawsuit, CMS issued preliminary communications that indicated the frailty exemption would resemble earlier CMS definitions. States made preparations for the work requirements based on that information, according to the suit.
By May, however, CMS was hinting that the exemption might become more complicated, telling states to disregard information shared a few days earlier. By May 29, Mike Levine, MassHealth’s former director, wrote a letter to CMS officials warning that final guidelines significantly different than those anticipated could create serious problems for the state.
When CMS released its guidelines, the results shocked state Medicaid administrators. CMS stated a determination of medical frailty alone wasn’t enough to obtain an exemption. The person must also demonstrate that their condition made them too unwell to work, the agency said.
Experts said such a standard would create enormous administrative burdens on enrollees, doctors, and MassHealth itself. They’ve also said it’s a confusing standard since many medical conditions, such as mental illness, are difficult, if not impossible, to measure in a way that can definitely determine whether someone can sustain employment.
In a declaration attached to the lawsuit, MassHealth’s current director, Dr. Ryan Schwarz, wrote the state estimated before the final guidelines were released that the work requirement could cause up to half of the 270,000 people on Medicaid through a 2014 expansion to lose coverage at some point. The final guidelines make it likely that number is now an underestimate, he said.
“MassHealth expects that more members who are actually eligible will be disenrolled simply because they are unable to demonstrate their eligibility,” he wrote.
Work requirements, increased eligibility checks, and changes to the Obamacare insurance marketplaces are estimated to contribute to roughly 300,000 losing coverage in Massachusetts, state officials have said.
States now face an Aug. 31 deadline to provide Medicaid recipients with details about how the work requirements will be implemented. The suit states that the guidelines are causing harm now by forcing Medicaid administrators to rush to adapt to the unexpected changes.
“This has a lot of substance to it,” Nicole Huberfeld, a Boston University professor of health law, said of the suit.
The abrupt shift in guidance despite the complexity of Medicaid reforms, the risk of error, and the departure from the language of the original law all make the suit a legitimate challenge to the administration, she said.
Adrianna McIntyre, an assistant professor of health policy and politics at Harvard’s T.H. Chan School of Public Health, agreed the suit raises valid questions about the gap between what the legislation states and how the administration is implementing the law. The suit’s major obstacle for now, she said, could be simply a matter of timing.
“The rule hasn’t taken effect yet,” she said. “The question becomes to what extent do the courts see the harms as hypothetical, versus are the states enduring harm right now?”
