Federal Judge Halts Trump Administration's Strict Medicaid Work Rule for Chronically Ill

A federal judge has blocked a new rule from the Trump administration that would have required chronically ill individuals enrolled in Medicaid to prove they are "medically frail" to receive exemptions from work requirements. US District Judge Richard Stearns issued the ruling on Thursday, supporting a lawsuit filed by 25 states and the District of Columbia in June. The plaintiffs argued that the rule unlawfully restricted exemptions for those with serious medical conditions.

The existing law defines medically frail to include individuals who are blind or disabled, have substance use disorders or disabling mental disorders, possess certain disabilities that significantly impede daily activities, or suffer from serious or complex medical conditions. However, the Trump administration's rule added a stipulation that individuals in these categories must demonstrate their conditions "significantly impair" their ability to meet the law's work requirements.

The states contended that this stricter interpretation would prevent eligible Americans from accessing necessary care and exceeded the scope of the law. Judge Stearns, in his 16-page decision, stated that the states had demonstrated irreparable harm, as monetary damages would be insufficient compensation, and they faced the burden of costly and complex alterations to their eligibility verification systems.

The Centers for Medicare & Medicaid Services, the agency responsible for the rule, declined to comment. Medicaid is a public health insurance program for low-income individuals, jointly funded by state and federal governments.

The ruling, however, does not invalidate the Medicaid work requirements themselves. These requirements, set to take effect on January 1, 2027, mandate that Medicaid expansion enrollees aged 19 to 64 must work, engage in community service for at least 80 hours per month, or be enrolled in school at least half-time. Exceptions are available for those deemed medically frail or participating in addiction treatment programs.

Judge Stearns, appointed by President Bill Clinton and serving in the District of Massachusetts, upheld two other federal restrictions concerning how states verify medical frailty, which were also challenged by the plaintiffs.