A federal judge in Boston on Thursday blocked the Trump administration from enforcing a stricter definition of who qualifies as “medically frail” to win exemptions from incoming Medicaid work requirements.
U.S. District Judge Richard Stearns delivered a partial victory to a coalition of 25 states and the District of Columbia, concluding that the Centers for Medicare and Medicaid Services overstepped the boundaries of the underlying statute when drafting its administrative rules, according to court documents cited by NBC News.
Extra burden on sick recipients invalidated
The dispute centers on implementation guidelines for President Donald Trump’s signature 2025 tax and domestic policy measure, known as the One Big Beautiful Bill Act. Under that law, adult Medicaid expansion recipients ages 19 to 64 must log at least 80 hours a month of employment, community service, or volunteer activities, or attend school at least half time, to maintain coverage.
While the statute exempted individuals deemed medically frail — including those who are blind, disabled, struggling with substance use or disabling mental disorders, or coping with serious and complex medical conditions — CMS added an extra requirement in guidance issued in June. The agency dictated that qualifying enrollees also had to prove their conditions “significantly impair” their ability to meet the community engagement mandate.
Stearns, who was appointed to the bench by former President Bill Clinton, wrote that the agency lacked the authority to narrow the exemption that way, NBC News reported.
“Because enforcement of an unlawful definition of ‘medically frail’ may lead to the disenrollment of otherwise eligible vulnerable individuals relying on Medicaid coverage for continuity of care, the States (and public) face potential for great hardship in the absence of an injunction,” Stearns wrote in his 16-page ruling.
The judge also observed that the coalition of states showed they would suffer irreparable harm because complying with the federal standard would force them to make expensive, labor-intensive revisions to their state eligibility systems, ABC News reported.
Core work requirements remain intact
The ruling does not dismantle the broader Medicaid work rules established under federal law. According to reports from NBC News and KATU, those requirements are scheduled to take effect Jan. 1, 2027, though ABC News reported the start date as Jan. 1 without specifying the year.
Stearns also ruled in favor of the federal government on other challenged provisions. He upheld requirements directing states to reject medical frailty documentation older than 12 months, as well as a guideline permitting states to accept only one self-attestation per continuous period of enrollment. Explaining that portion of his decision, Stearns said federal officials offered a rational basis for adopting those verification safeguards and reasonably addressed states’ disenrollment worries, ABC News reported.
Additionally, Stearns instructed states to wait at least six months after the work requirements begin before terminating coverage for anyone seeking a medical exemption, KATU reported, granting state agencies breathing room to adjust their processing operations.
What happens next
The lawsuit was led by attorneys general in California, Massachusetts and New Jersey before expanding into a multi-state coalition. Democratic officials praised the ruling as a crucial safeguard for vulnerable residents who rely on the joint federal and state healthcare safety net.
Representatives for CMS and the Department of Health and Human Services did not immediately respond to requests for comment, and CMS declined to state whether the administration plans to appeal the decision, according to reports from ABC News and KATU.
