Judge blocks Trump administration’s Medicaid work requirement rule requiring proof of medical frailty

WASHINGTON (AP) — Chronically ill people on Medicaid won’t be bound by new work requirement rules required by the Trump administration’s latest guidance in order to qualify for “fragile drug” exemptions, a federal judge ruled Thursday.

U.S. District Judge Richard Stearns in Boston gave a partial victory to a coalition of 25 states and the District of Columbia, which sued the Trump administration in June over new guidance from the Centers for Medicare and Medicaid Services related to the 2025 law known as the “One Big Beautiful Bill.”

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The law states that the definition of “medically fragile” must include individuals who are blind or disabled, have disabling substance use disorders or mental health disorders, have certain disabilities that significantly interfere with daily activities, or have serious or complex health conditions. But the CMS rule went further, requiring people in these categories to demonstrate 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 also override the text of the law itself.

“States have faced their burden of demonstrating irreparable harm for which monetary damages would provide inadequate compensation – they face the burden of costly and intensive changes to their eligibility verification systems,” Stearns said in his 16-page ruling.

Notably, although the ruling will make it easier for certain Medicaid beneficiaries with qualifying medical conditions to obtain an exemption from the new work requirements, Stearns’ ruling does not strike down the work requirements as unlawful.

Additionally, Stearns maintained two other federal restrictions on how states can verify medical frailty: including the requirement that states reject proof of patients’ medical frailty if the diagnosis is more than a year old. He also supported a policy allowing states to accept only one self-attestation per continuous period of enrollment.

Explaining why he kept the parties in favor of the government, Stearns said that “the government provided a non-frivolous rationale for adopting each provision and explained why it did not find states’ concerns about opt-out compelling.”

Representatives for 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 bill in 2025. The change affects people covered by an expansion in most states that allowed more low-income people to access the government’s Social Security program.

Starting Jan. 1, expansion enrollees ages 19 to 64 must prove they work or perform community service at least 80 hours per month, or are in school at least half the time. There are exceptions for people considered medically fragile or participating in drug treatment programs, among others.