Health · Healthcare & Policy · 5 hrs ago
Federal judge rejects Medicaid rule defining who is medically frail
A federal judge in Massachusetts rejected the government’s definition of medical frailty for Medicaid work requirement exemptions.
The ruling came in a lawsuit brought by more than two dozen states.
The rules were due to take effect soon and require some Medicaid recipients to meet work requirements to qualify for coverage.
People considered medically frail can be exempt, but the judge found the new definition too restrictive.
He also said states lacked enough time and resources to change their eligibility systems.
The judge said applying the definition could cause vulnerable people to lose Medicaid coverage and disrupt their care.
The ruling blocks the rule as written, leaving uncertainty about the planned rollout.
A federal judge rejected a federal rule requiring some sick Medicaid enrollees to show that their conditions significantly impair their ability to meet work requirements to qualify as medically frail.
U.S. District Judge Richard Stearns ruled Thursday in a lawsuit brought by 25 states and the District of Columbia.
The ruling does not strike down Medicaid work requirements, which are due to begin Jan. 1 for many expansion enrollees.
Stearns upheld other federal restrictions on how states verify medical frailty, including rejecting diagnoses more than a year old.
- Who
- U.S. District Judge Richard Stearns ruled in a lawsuit brought by 25 states and the District of Columbia against the Trump administration.
- What
- He rejected the federal requirement that qualifying medical conditions also significantly impair a person’s ability to meet work requirements to count as medically frail.
- When
- Thursday, Oct. 29, 2026.
- Where
- U.S. District Court in Massachusetts; Stearns issued the ruling in Boston.
- Why
- The states argued that the stricter rule exceeded the law and could prevent eligible people from keeping Medicaid coverage.
States and the District of Columbia
Trump administration
Definition of medically frail
States and the District of Columbia
The states argued that the law did not require qualifying people to prove their conditions also impair their ability to meet work requirements.
Trump administration
The administration’s rule required that additional showing.
Effects of the rule
States and the District of Columbia
The states said the stricter definition could block eligible people from care and force costly changes to state eligibility systems.
Trump administration
The government argued for the rule; Stearns said it provided a non-frivolous rationale for the other restrictions he upheld.
The One Big Beautiful Bill became law and included Medicaid work requirements and rules for medical-frailty exemptions.
25 states and the District of Columbia sued the Trump administration over the CMS guidance.
Judge Richard Stearns rejected the requirement that qualifying medical conditions also significantly impair enrollees’ ability to meet work requirements.
Work requirements are set to begin for Medicaid expansion enrollees aged 19 to 64.
- Plaintiffs
- 25 states and the District of Columbia
- Judge
- Richard Stearns, U.S. District Court for Massachusetts
- Work requirement
- 80 hours a month of work or community service, or attendance at school at least half the time
- Affected enrollees
- Medicaid expansion enrollees aged 19 to 64
- Other restrictions upheld
- Rejecting diagnoses more than a year old and allowing one self-attestation per continuous enrollment period
4 sources
Judge rules CMS overstepped on ‘medically frail’ definition for Medicaid work requirements
Judge Blocks Trump Admin's Medicaid Rule Forcing Sick Recipients to Prove Frailty
Medicaid rule forcing sick enrollees to prove frailty blocked by judge
STAT+: Federal judge rejects new Medicaid ‘frailty’ definition for work requirements
What people are saying
The states have met their burden of showing irreparable harm for which monetary damages would provide inadequate compensation — they face the burden of costly and intensive alterations to their eligibility verification systems.
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.
Those individuals who would have lost coverage because they’re sick but they’re not quite sick enough, they might have their coverage preserved now.
One of our top priorities is to make sure people can get the critical health care they need without facing confusing paperwork or the fear of losing coverage during treatment.