Chronically ill people on Medicaid won’t be bound by new work requirement rules mandated by the Trump administration for qualifying for “medically frail” exemptions, a federal judge ruled Thursday, reports BritPanorama.
US District Judge Richard Stearns in Boston granted a partial victory to a coalition of 25 states and the District of Columbia, which sued the Trump administration in June over the Centers for Medicare and Medicaid Services (CMS) guidance linked to the One Big Beautiful Bill Act. This law introduced the first-ever federal work requirement for Medicaid.
The legislation defines “medically frail” to include individuals who are blind or disabled, have substance use disorders or disabling mental disorders, or have serious medical conditions. However, the CMS rule imposed additional requirements, mandating that these individuals demonstrate that their conditions “significantly impair” their ability to comply with the new work requirements.
This ruling has significant implications as it allows some individuals to avoid the burdensome paperwork that could be required to prove their medical conditions prevent them from working. States, already racing against a deadline to implement the work requirement by January 1, are now compelled to adjust their plans once again due to the surprise nature of the CMS guidance issued in June.
Advocates previously expressed concern that the CMS rule would create substantial obstacles for patients, potentially unfairly disqualifying them from coverage. The judge agreed with the plaintiffs, stating that enforcing the stricter interpretation could lead to the disenrollment of otherwise eligible individuals relying on Medicaid for their healthcare needs.
“Because enforcement of an unlawful definition of ‘medically frail’ may lead to the disenrollment of otherwise eligible vulnerable individuals relying on Medicaid coverage for continuity of care, the States (and public) face potential for great hardship in the absence of an injunction,” Stearns noted in his decision.
Morgan Henderson, an economist studying Medicaid at the Hilltop Institute, remarked that the ruling will help those previously at risk of losing coverage due to their medical conditions. “Those individuals who would have lost coverage because they’re sick but they’re not quite sick enough,” he explained, “they might have their coverage preserved now.”
Dr. Dev Sangvai, Secretary of North Carolina Health and Human Services, emphasized the importance of ensuring patients can access critical healthcare without the stress of confusing bureaucratic requirements. “This decision allows us to focus on what matters most: delivering reliable health care to our state’s most vulnerable residents when they need it most,” he stated.
However, the ruling was not entirely in favor of the states. Judge Stearns upheld certain federal restrictions, including rejecting medical frailty proof if the diagnosis is older than one year and limiting self-attestations to one per enrollment period. The judge justified these rulings by asserting that the government presented valid reasons for adopting these provisions.
CMS has chosen not to comment on the ruling. The new Medicaid restrictions are part of the broader changes implemented under Trump’s 2025 tax and policy law, which affects individuals covered through the expansion of Medicaid aimed at supporting lower-income residents.
Beginning January 1, Medicaid expansion enrollees aged 19 to 64 will be required to show they work or perform community service for at least 80 hours each month, or attend school part-time. Some states, including Nebraska and Montana, have already begun enforcing these mandates. According to estimates from the Congressional Budget Office, approximately 5.3 million more individuals are expected to lack insurance by 2034 due to this requirement.
The implications of this ruling, alongside the challenges of implementing the work requirement, continue to unfold as stakeholders react and adapt to the changing landscape of Medicaid policy.
