AG Jeff Jackson says CMS illegally narrowed protections for medically frail residents, putting tens of thousands at risk of losing care.
North Carolina Attorney General Jeff Jackson filed suit on Monday, June 29, 2026, against the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human Services, arguing that a new federal rule could cause tens of thousands of medically frail North Carolinians to lose Medicaid coverage while undergoing treatment for cancer and other severe illnesses.
The lawsuit challenges CMS’s June 1 decision to narrow the definition of “medically frail,” a category Congress specifically protected when it passed H.R. 1, the One Big Beautiful Bill Act. The federal law added new work‑requirement rules for Medicaid expansion adults but exempted people with serious conditions such as cancer, muscular dystrophy, cystic fibrosis, hemophilia, Parkinson’s disease, and other life‑threatening illnesses.
Jackson says CMS’s revised definition violates congressional intent and puts vulnerable patients at risk.
“This is cruel and illegal,” Jackson said. “The sickest people in North Carolina are being put at risk of losing healthcare while they are still in treatment.”
Patients and physicians quoted in the filing say the rule could cause eligible residents to lose coverage because of paperwork mistakes, fluctuating symptoms, or the burden of obtaining additional medical documentation. State health officials warn the change creates barriers to care and adds strain to county social services offices already facing staffing shortages.
More than 730,000 North Carolinians have gained coverage since Medicaid expansion began in 2023. State estimates indicate the new rule could affect tens of thousands of medically frail residents, potentially up to nearly 100,000.
North Carolina is joined in the lawsuit by 22 Attorneys General and the Governors of Kentucky and Pennsylvania. The suit asks the court to block CMS from implementing the new definition while allowing the rest of H.R. 1 to proceed.
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