Judge Blocks Trump Administration's Medicaid Work Requirements for Medically Frail

A federal judge in Boston has blocked a Trump administration rule that would have required chronically ill Medicaid recipients to prove their frailty to qualify for exemptions from work requirements. U.S. District Judge Richard Stearns ruled Thursday that these individuals will not be bound by the stricter guidance issued by the Centers for Medicare and Medicaid Services (CMS).

The ruling partially sided with a coalition of 25 states and the District of Columbia, which sued the administration in June over the guidance. The plaintiffs argued that the stricter rule, which required individuals in categories like blindness, disability, substance use disorders, or serious medical conditions to also demonstrate that their conditions “significantly impair” their ability to comply with work requirements, would prevent eligible Americans from accessing necessary care and exceeded the bounds of the law.

Stearns stated in his 16-page ruling that the states had demonstrated irreparable harm, citing the burden of costly and intensive alterations to their eligibility verification systems. However, the decision does not invalidate the work requirements themselves. It also upholds certain federal restrictions on how states can verify medical frailty, including the requirement that diagnoses must be no more than a year old and that states may only accept one self-attestation per enrollment period.

Stearns explained that he upheld these specific portions in favor of the government because officials provided a “non-frivolous rationale” for adopting them and did not find the states’ concerns about disenrollment compelling. Representatives from the Department of Health and Human Services and CMS did not immediately respond to requests for comment.

The Medicaid restrictions are part of a larger law enacted in 2025. Beginning January 1, expansion enrollees aged 19 to 64 must work or engage in community service for at least 80 hours per month, or be enrolled in school at least half-time, to maintain coverage. Exemptions exist for those deemed medically frail or participating in addiction treatment programs, among other categories.