By Karim Hammam
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 required to qualify for “medically frail” exemptions.
Partial victory for states
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.” The law defines medically frail to include people who are blind, disabled, have substance use or mental disorders, or serious medical conditions. The CMS rule added a requirement that those conditions also “significantly impair” the ability to comply with work requirements.
Judge’s reasoning
Stearns wrote that the states showed irreparable harm because they would face costly changes to eligibility verification systems. The ruling makes it easier for some Medicaid recipients with qualifying conditions to obtain exemptions, but does not strike down the work requirements themselves.
Upheld restrictions
The judge upheld two other federal restrictions: states must reject proof of medical frailty if the diagnosis is more than a year old, and states may accept only one self-attestation per continuous enrollment period. Stearns said the government provided a non-frivolous rationale for those provisions.
Work requirements take effect
Starting Jan. 1, Medicaid expansion enrollees aged 19 to 64 must show they work or perform community service at least 80 hours a month, or are in school at least half-time. Exceptions exist for those deemed medically frail or in addiction treatment.
