WASHINGTON (AP) — Chronically ill people on Medicaid won't be bound by new work requirement rules that the latest Trump administration guidance requires in order to qualify for “medically frail” exemptions, a federal judge ruled Thursday.
U.S. District Judge Richard Stearns in Boston gave a partial victory to a coalition of 25 states and the District of Columbia, which sued the Trump administration in June over the new Centers for Medicare and Medicaid Services guidance linked to the 2025 law known as the “One Big Beautiful Bill.”
The law says the definition of medically frail must include people who are blind or disabled, have substance use disorders or disabling mental disorders, have certain disabilities that significantly impair daily activities, or have serious or complex medical conditions. But the CMS rule went further, requiring people in those categories to show that their conditions also “significantly impair” their ability to comply with the law’s work requirements.
The plaintiffs argued that the stricter rule would prevent eligible Americans from accessing the care they need — and oversteps the text of the law itself as well.
“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,” Stearns said in his 16-page ruling.
Notably, while the ruling will make it easier for some Medicaid recipients with qualifying medical conditions to obtain an exemption from the new work requirements, Stearns' decision does not strike down the work requirements as unlawful.
It is likely to mean some people will be able to obtain or keep coverage, said Morgan Henderson, an economist who studies Medicaid at The Hilltop Institute at the University of Maryland, Baltimore County. “Those individuals who would have lost coverage because they’re sick but they’re not quite sick enough,” he said, "they might have their coverage preserved now.”
North Carolina Health and Human Services Secretary Dev Sangvai said it would also help patients avoid some stressful situations.
“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," he said in a statement. "This decision allows us to focus on what matters most: delivering reliable health care to our state’s most vulnerable residents when they need it most.”
Additionally, Stearns upheld two other federal restrictions on how states can verify medical frailty, including the requirement that states reject proof of patients’ medical frailty if the diagnosis is more than a year old. He also upheld a policy allowing states to accept only one self-attestation per continuous period of enrollment.
Explaining why he upheld the portions in favor of the government, Stearns said “the government provided a non-frivolous rationale for adopting each provision and explained why it did not find the States’ concerns of disenrollment compelling."
CMS declined to comment.
The new Medicaid restrictions are part of Trump’s big tax and policy law in 2025. The change affects those covered through an expansion in most states that gave more lower-income people access to the government’s safety net healthcare program.
Starting Jan. 1, expansion enrollees aged 19 to 64 must show that they work or do community service at least 80 hours a month, or are in school at least half the time. There are exceptions for those considered medically frail or in addiction treatment programs, among others.
Associated Press reporter Geoff Mulvihill contributed to this article from Haddonfield, New Jersey.
Centers for Medicare & Medicaid Services administrator Dr. Mehmet Oz and Health and Human Services Secretary Robert F. Kennedy Jr. arrive before President Donald Trump speaks at a campaign rally at Alico Arena on the campus of Florida Gulf Coast University, Friday, Oct. 23, 2026, in Fort Myers, Fla. (AP Photo/Mark Schiefelbein)
President Donald Trump talks with reporters after arriving on Air Force One, Friday, Oct. 23, 2026, at President Donald J. Trump International Airport in West Palm Beach, Fla., as Health and Human Services Secretary Robert F. Kennedy Jr. and Centers for Medicare & Medicaid Services administrator Dr. Mehmet Oz listen. (AP Photo/Mark Schiefelbein)
