Judge Blocks Part of Medicaid Exemption Guidance
A federal judge has blocked part of Trump administration guidance governing which Medicaid recipients qualify for exemptions from new work requirements. The decision allows people with chronic illnesses and other qualifying conditions to seek a “medically frail” exemption without showing that their condition also prevents them from meeting the work rules.
U.S. District Judge Richard Stearns issued the ruling in Boston after 25 states and the District of Columbia challenged guidance from the Centers for Medicare and Medicaid Services. The guidance implements provisions of a 2025 tax and policy law known as the “One Big Beautiful Bill.”
The law identifies several groups that must be included in the medically frail category, including people who are blind or disabled, have substance use disorders or disabling mental disorders, have disabilities that substantially limit daily activities, or have serious or complex medical conditions. CMS added a requirement that applicants demonstrate their conditions significantly impair their ability to meet work requirements.
The states argued that the additional test exceeded the law and could deny eligible people access to coverage. Stearns found that the states faced irreparable harm because complying with the guidance would require costly changes to their eligibility systems.
The ruling does not invalidate the work requirements. Stearns also upheld two other provisions: states must reject evidence of medical frailty based on diagnoses more than a year old, and may accept only one self-attestation during each continuous enrollment period. He said the federal government had offered a rationale for those policies.
Under the law, Medicaid expansion enrollees ages 19 through 64 must complete 80 hours of work or community service each month, or attend school at least half time, beginning January 1. Exemptions include medically frail people and those in addiction treatment. Federal health officials did not immediately respond to a request for comment.