Judge blocks Medicaid rule requiring frail patients to prove work limitations

Chronic illness patients on Medicaid in 25 states and the District of Columbia will avoid a new administrative hurdle designed to limit exemptions from work requirements. A federal judge in Boston ruled on Thursday that the Trump administration’s latest guidance on defining medical frailty is too strict for the law it purports to enforce.

The decision grants a partial victory to a coalition of states that sued the administration in June. The lawsuit challenged Centers for Medicare and Medicaid Services guidance linked to the 2025 legislation known as the One Big Beautiful Bill. That law defines medically frail individuals as those who are blind, disabled, or have substance use disorders, disabling mental disorders, or serious medical conditions.

The contested CMS rule added an extra layer of scrutiny. It required eligible individuals to demonstrate that their conditions significantly impair their ability to meet the law’s work requirements. U.S. District Judge Richard Stearns found this addition went beyond the text of the statute. In a 16-page ruling, Stearns stated that the states showed irreparable harm because they faced the burden of costly and intensive alterations to their eligibility verification systems.

The ruling does not eliminate the work requirements themselves. Expansion enrollees aged 19 to 64 must still show that they work or do community service for at least 80 hours a month, or attend school at least half the time, starting January 1. Exceptions remain for those considered medically frail or in addiction treatment.

Stearns upheld two other federal restrictions on how states verify medical frailty. He maintained the requirement that states reject proof of frailty if the diagnosis is more than a year old. He also upheld a policy allowing states to accept only one self-attestation per continuous period of enrollment. Stearns explained that the government provided a non-frivolous rationale for these specific provisions.

The change affects individuals covered through Medicaid expansion, a policy that extended government healthcare access to more lower-income people in most states. Representatives from the Department of Health and Human Services and CMS did not immediately respond to a request for comment on the ruling.