A federal judge in Boston ruled Thursday that chronically ill people on Medicaid will not be bound by new work-requirement rules that require them to prove they are medically frail in order to qualify for an exemption.3,5
U.S. District Judge Richard Stearns gave a partial victory to a coalition of 25 states and the District of Columbia, which sued the Trump administration in June over new Centers for Medicare and Medicaid Services guidance linked to the 2025 law known as the One Big Beautiful Bill. The Hill described the administration's definition as unlawful and said Stearns issued a temporary injunction on states having to determine medical frailty under it.3,5
At issue is who counts as medically frail and therefore excused from the law's work requirements. The law says the definition must include people who are blind or disabled, people with substance use disorders or disabling mental disorders, people with certain disabilities that significantly impair daily activities, and people with serious or complex medical conditions.3
The CMS guidance went further. It required people in those categories to show that their conditions also significantly impair their ability to comply with the law's work requirements. The plaintiff states argued that the stricter test would prevent eligible Americans from getting the care they need and goes beyond the text of the law itself.3
Stearns found that the states had shown they would be harmed without court action. "The states have met their burden of showing irreparable harm for which monetary damages would provide inadequate compensation — they face the burden of costly and intensive alterations to their eligibility verification systems," Stearns said in his 16-page ruling.3
The decision will make it easier for some Medicaid recipients with qualifying medical conditions to obtain an exemption from the new work requirements. Stearns did not strike down the work requirements themselves as unlawful.3
In the same ruling, Stearns upheld two other federal limits on how states verify medical frailty. He left in place a requirement that states reject proof of medical frailty if the diagnosis is more than a year old, and a policy allowing states to accept only one self-attestation per continuous period of enrollment.3
In explaining why he ruled for the government on those two provisions, Stearns said "the government provided a non-frivolous rationale for adopting each provision and explained why it did not find the States' concerns of disenrollment compelling."3
Representatives from the Department of Health and Human Services and CMS did not immediately respond to an Associated Press request for comment.3
The new Medicaid restrictions are part of Trump's big tax and policy law in 2025. The change affects people covered through an expansion in most states that gave more lower-income people access to the government's safety-net health care program.3
Starting Jan. 1, expansion enrollees ages 19 to 64 must show that they work or perform community service at least 80 hours a month, or are in school at least half the time. There are exceptions for those considered medically frail and for people in addiction treatment programs, among others.3
For now, states face the January requirements without the additional proof-of-impairment test for frailty, but with the one-year diagnosis and single-attestation limits still in place.3,5
