Judge strikes down Trump admin’s definition of ‘fragile drug’ in Medicaid work rules

A federal judge in Boston on Thursday sided with a coalition of 25 Democratic-led states and the District of Columbia in a lawsuit challenging the Trump administration’s requirement that states require chronically ill people on Medicaid to prove that they are unable to work .

During oral arguments last week, the states said that unless the court blocks this piece of the rule before January and allows them to exempt people with certain diagnosed illnesses, they would be “required…to bear the costs and burdens of implementing this unlawful limitation.”

Judge Richard Stearns appointed by the president Bill Clinton said guidelines released in June by the Centers for Medicare and Medicaid Services went beyond what Congress passed in 2025 in the Act on a big and beautiful bill and is “therefore contrary to the law”.

“There is an inherent public interest in ensuring that the government follows the law,” he said, adding that “enforcing an unlawful definition of ‘medically fragile’ can lead to the removal of otherwise eligible vulnerable individuals relying on Medicaid coverage for continuity of care.”