Judge blocks stricter Medicaid exemption rule for chronically ill

Medicaid work requirements remain; states win partial court victory

U.S. District Judge Richard Stearns ruled Thursday that chronically ill people on Medicaid are not bound by the Trump administration’s stricter requirements for qualifying as “medically frail” and exempt from new work rules. The decision in Boston handed a partial victory to a coalition of 25 states and the District of Columbia, which sued the administration in June.

The states challenged guidance from the Centers for Medicare and Medicaid Services tied to the 2025 law known as the “One Big Beautiful Bill.” The law says the definition of medically frail must include people who are blind or disabled, have substance use disorders or disabling mental disorders, have certain disabilities that significantly impair daily activities, or have serious or complex medical conditions.

The CMS rule went further, requiring people in those categories to show that their conditions also “significantly impair” their ability to comply with the law’s work requirements. The plaintiffs argued that the stricter rule would prevent eligible Americans from accessing the care they need, and that it oversteps the text of the law itself.

In his 16-page ruling, Stearns said the states had made the required showing. “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,” he said.

The ruling makes it easier for some Medicaid recipients with qualifying medical conditions to obtain an exemption from the new work requirements. It does not strike down the work requirements as unlawful.

Stearns also upheld two other federal restrictions on how states verify medical frailty: a requirement that states reject proof of a patient’s frailty when the diagnosis is more than a year old, and a policy allowing states to accept only one self-attestation per continuous period of enrollment. He 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.”

Representatives from the Department of Health and Human Services and CMS did not immediately respond to an Associated Press request for comment.

The new Medicaid restrictions are part of Trump’s big tax and policy law in 2025. They affect people covered through an expansion in most states that gave more lower-income people access to the government’s safety net health care program.

Starting Jan. 1, expansion enrollees aged 19 to 64 must show that they work or do 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 or in addiction treatment programs, among others.