A federal judge in Boston ruled on Thursday that the Trump administration went beyond the law when it narrowed who counts as "medically frail" under the Medicaid work requirements that take effect on January 1, and he permanently blocked the disputed language.
Judge Richard Stearns, of the US District Court for the District of Massachusetts, was ruling on a suit filed in June by 25 states and the District of Columbia against an interim final rule issued by the Centers for Medicare & Medicaid Services (CMS). The decision vacates the contested wording and leaves the work requirements themselves standing.
What the law says, and what the rule added
The 2025 budget law known as the One Big Beautiful Bill Act exempts "medically frail" enrollees from the new requirements. It defines the category to include people who are blind or disabled, people with substance use disorders or disabling mental disorders, people with disabilities that significantly limit daily activities, and people with serious or complex medical conditions.
The CMS guidance asked for one step more: a person in any of those categories would also have to show that the condition significantly impairs their ability to meet the work requirement. The states argued that the extra test has no basis in the statute and would keep eligible people from care they are entitled to. Stearns struck it.
Two other provisions survived. States may refuse proof of medical frailty when the diagnosis is more than a year old, and they may accept only one self-attestation of frailty per continuous enrollment period. The judge found that the government had offered a rationale for both that was not frivolous.
The January 1 deadline
From January 1, Medicaid expansion enrollees between the ages of 19 and 64 must work or perform community service for at least 80 hours a month, or be enrolled in school at least half-time. Exemptions apply to the medically frail, to people in addiction treatment programs and to others.
The court gave the plaintiff states a six-month stay of enforcement — time to rework the eligibility systems that will have to apply the rule. On the question of harm, Stearns found those changes costly enough to be irreparable, which is to say the states' winning argument on that point was administrative rather than medical.
California Attorney General Rob Bonta, who led the coalition, called the decision "a major victory" and said that "people with serious illnesses or disabilities should not have to worry about losing their healthcare." The Department of Health and Human Services and CMS did not immediately comment on the ruling.
The decision settles one clause, not the policy. Work requirements remain law, the verification machinery is still being built state by state, and the sentence the court removed was the one that decided who would never have to prove anything at all.
Reporting from the Office of the California Attorney General, PBS NewsHour and the Associated Press.
