Judge blocks stricter Medicaid medical-frailty test
U.S. District Judge Richard Stearns ruled that the federal government cannot enforce its stricter definition of “medically frail,” which would have made some people with qualifying health conditions show that those conditions significantly limited their ability to meet Medicaid work requirements. Twenty-five states plus D.C. sued over instructions from the federal agency administering Medicare and Medicaid, tied to the 2025 statute titled the One Big Beautiful Bill Act.
The statute identifies groups that must be included in the medically frail category, including individuals with blindness or disabilities, people with addiction-related disorders or serious mental illness, or those with serious or complex medical conditions. The states argued the federal guidance went beyond that law and could put eligible people’s coverage at risk. Stearns found they had shown likely irreparable harm, including the expense and effort of changing eligibility systems on a tight schedule.
The ruling does not cancel Medicaid’s new work requirements. Beginning January 1, expansion enrollees ages 19 to 64 must document at least 80 hours a month of work or community service, or attendance at school at least half time, unless they qualify for an exception.
Stearns left two other federal verification rules in place: states must reject medical-frailty evidence based on a diagnosis more than a year old, and may accept only one self-attestation during a continuous enrollment period. The decision gives states a different standard to apply as they prepare their systems, while the work mandate remains in place.
Court blocks a Medicaid rule that risked sick people’s coverage
A federal judge has stopped the administration from making chronically ill Medicaid recipients prove that their conditions prevent them from meeting work rules before they can qualify as medically frail. The decision protects access to exemptions written into the 2025 law, after 25 states and the District of Columbia challenged federal guidance they said exceeded the statute and threatened coverage.
The ruling matters because the CMS standard demanded more than the law’s categories: individuals with blindness or disabilities, people with addiction-related disorders or serious mental illness, or those with serious or complex conditions would also have had to show their health significantly impaired compliance with work requirements. Judge Richard Stearns found the states demonstrated likely irreparable harm, including costly, intensive changes to eligibility systems under a tight deadline.
The work mandate itself remains. From January 1, Medicaid expansion enrollees ages 19 to 64 generally must document 80 monthly hours of work or community service, or attend school at least half time. But the court’s decision removes this added hurdle for some people seeking a medical exemption—an important limit on a policy that could otherwise place coverage at risk during illness.
The judge kept other federal checks: states must reject proof based on a diagnosis older than a year and may accept only one self-attestation per uninterrupted enrollment period. The ruling is a partial victory, not a repeal of the work requirements.
Medicaid work mandate survives ruling against frailty test
The central point of the Boston ruling is what it did not do: Medicaid’s new work requirements remain in force. Judge Richard Stearns blocked the administration’s demand that some chronically ill recipients prove their conditions significantly impair their ability to comply with those rules, granting a partial victory to 25 states and the District of Columbia.
The law, passed in 2025, requires Medicaid expansion enrollees ages 19 to 64 to show 80 hours a month of work or community service, or attendance at school at least half time, beginning January 1, subject to exceptions. The judge’s decision changes how one exemption is assessed; it does not strike down the mandate itself. That distinction matters as states prepare eligibility systems for the new requirements.
Stearns also upheld two federal verification limits: states must reject medical-frailty evidence tied to diagnoses more than a year old and may accept one self-attestation per continuous enrollment period. He said the government had offered a reasoned basis for those provisions, rejecting the states’ challenge to them.
The states argued the additional frailty test exceeded the law and risked disenrolling eligible people. The judge found they showed likely harm from the rule, including expensive system changes. The outcome therefore narrows the administration’s approach to exemptions while preserving the broader work policy and significant verification requirements.
Reported by STAT, The Philadelphia Inquirer, PBS NewsHour, The Washington Examiner, CNN.
