Judge halts strict Medicaid frailty proof requirement

Chronic illness patients enrolled in Medicaid will no longer face new federal paperwork hurdles to prove their conditions prevent them from working, according to a ruling issued Thursday by a federal judge in Boston. The decision lifts a temporary block on a specific provision of the Trump administration's recent Medicaid guidance, allowing states to grant exemptions based on the criteria set by Congress rather than stricter administrative rules.

U.S. District Judge Richard Stearns issued a partial victory for a coalition of 25 states and the District of Columbia. The group filed suit in June against the Centers for Medicare and Medicaid Services, arguing that its interpretation of the 2025 "One Big Beautiful Bill" exceeded the law's text. The statute defines medically frail individuals as those who are blind or disabled, have substance use or mental disorders, or possess serious medical conditions. The CMS rule, however, required these individuals to demonstrate that their conditions specifically impaired their ability to meet new work requirements.

Stearns found that the administration's extra layer of scrutiny created irreparable harm for the states. In his 16-page opinion, he noted that the government's approach forced jurisdictions to make costly and intensive changes to their eligibility verification systems. "The states have met their burden of showing irreparable harm for which monetary damages would provide inadequate compensation," Stearns wrote.

The ruling does not eliminate the new work mandates. It also does not strike down other parts of the CMS guidance. Stearns upheld a federal restriction that allows states to reject medical frailty diagnoses if they are more than one year old. He also maintained a policy permitting states to accept only one self-attestation per continuous enrollment period. Regarding these upheld measures, the judge stated that the government provided a non-frivolous rationale and did not find the states' concerns about disenrollment compelling.

The changes are part of a broader 2025 tax and policy law. They primarily affect Medicaid expansion enrollees, a group that expanded access to government healthcare for lower-income residents in most states. HHS and CMS officials did not immediately respond to a request for comment from the Associated Press.

Under the new rules, expansion enrollees aged 19 to 64 must begin meeting work or school requirements on Jan. 1. They must complete at least 80 hours of work or community service per month, or attend school at least half the time. Exceptions exist for those in addiction treatment or deemed medically frail under the judicially approved definition.