Federal judge blocks new Medicaid rule on medical frailty
Judge Richard Stearns ruled against the administration's stricter definition, siding with 25 states in a dispute over work requirement exemptions.
By Matthew Qureshi ·
A federal judge in Massachusetts blocked a new rule from the Trump administration.
The rule required chronically ill Medicaid recipients to prove their conditions made them medically frail to avoid work requirements. Judge Richard Stearns issued the ruling on Thursday. He sided with 25 states and the District of Columbia. These jurisdictions sued the administration in June. They argued the rule limited exemptions for people with serious medical conditions beyond what the law allowed.
Federal law defines medically frail individuals. It includes people who are blind or disabled. It also covers those with substance use disorders, disabling mental disorders, or conditions that severely limit daily activities. The administration's rule added a layer. It required people in these groups to show their conditions also significantly impaired their ability to comply with work rules.
Plaintiffs argued this added step would block eligible Americans from accessing care. They claimed the rule went past the text of the law. In his 16-page decision, Stearns noted the states faced irreparable harm. He wrote that they faced the burden of costly and intensive alterations to their eligibility verification systems.
The Centers for Medicare & Medicaid Services adopted the rule. The agency declined to comment on the ruling. Medicaid is a public health insurance program for low-income people. It is funded by state and federal governments.
The work requirements take effect on January 1, 2027. From that date, Medicaid expansion enrollees aged 19 to 64 must show they work or do community service at least 80 hours a month. They may also qualify if they are in school at least half the time. Exceptions exist for those considered medically frail or in addiction treatment programs.
The ruling makes it easier for some recipients with qualifying medical conditions to obtain an exemption. It does not strike down the work requirements as unlawful. Stearns, who was appointed by President Bill Clinton, also upheld two other federal restrictions on how states can verify medical frailty. These were part of the same challenge brought by the states and the District of Columbia.
