By Fatma Younis
A federal judge in Boston ruled Thursday that chronically ill Medicaid recipients will not be bound by new work‑requirement rules that the Trump administration had tied to “medically frail” exemptions. U.S. District Judge Richard Stearns granted a partial victory to a coalition of 25 states and the District of Columbia, which sued in June over guidance from the Centers for Medicare and Medicaid Services linked to the 2025 “One Big Beautiful Bill.”
Rule Went Beyond Statute
The law defines medically frail individuals to include those who are blind or disabled, have substance‑use or disabling mental disorders, have impairments that significantly limit daily activities, or have serious medical conditions. The CMS rule added a requirement that people in those categories also prove their conditions “significantly impair” their ability to meet work requirements. The plaintiffs argued the stricter standard would block eligible Americans from care and exceeded the law’s text.
Irreparable Harm Cited
Stearns wrote that the states demonstrated irreparable harm because they would face costly, intensive changes to their eligibility verification systems. His 16‑page ruling does not strike down the work requirements themselves, only the added frailty‑proof provision.
Other Restrictions Upheld
The judge upheld two other federal provisions: states may reject medical‑frailty proof if the diagnosis is more than a year old, and they may accept only one self‑attestation per continuous enrollment period. Stearns said the government provided a non‑frivolous rationale for those rules.
No Immediate Comment
Representatives for the Department of Health and Human Services and CMS did not immediately respond to a request for comment.
Work Requirements Take Effect in January
Starting Jan. 1, Medicaid expansion enrollees aged 19 to 64 must show they work, perform community service, or attend school at least 80 hours a month. Exceptions remain for those deemed medically frail or in addiction treatment. The restrictions are part of the broader 2025 tax and policy law.
