Judge Blocks Part of Medicaid Work Requirement Rule Affecting Seriously Ill Patients

A federal judge has blocked part of a new rule on Medicaid work requirements. The Associated Press reported that U.S. District Judge Richard Stearns in Boston ruled on Thursday, October 29 that the federal government went too far when it narrowed the definition of who counts as medically frail. The ruling was a partial victory for a coalition of 25 states and the District of Columbia that sued in June. Massachusetts Attorney General Andrea Joy Campbell helped lead the case.

Here is the background. Congress passed Medicaid work requirements as part of a large tax and spending law in 2025, known as the One Big Beautiful Bill. Under the law, adults ages 19 to 64 who get coverage through Medicaid expansion must work or do community service at least 80 hours a month, or attend school at least half time. The requirements are set to take effect on January 1. The law includes exemptions for people who are medically frail, such as those who are blind or disabled, people with substance use disorders or disabling mental disorders, and people with serious or complex medical conditions.

The dispute centered on guidance from the Centers for Medicare and Medicaid Services. The agency's rule required people in those exempt categories to also show that their conditions significantly impair their ability to meet the work rules. Judge Stearns found that this extra step unlawfully limited who qualifies as medically frail under the law.

The judge left other parts of the guidance in place. Under the upheld rules, states may look back only twelve months when they review claims and encounter data to identify people who qualify as medically frail. The judge accepted the government's reasoning that older records might not reflect a person's current condition. States may also accept only one self attestation from a patient per enrollment period. The work requirements themselves were not struck down.

The court also gave the suing states some breathing room. In the written opinion, the judge granted a six month stay of enforcement that applies specifically to determinations of whether individuals qualify for the medical frailty exemption. That cushion gives states time to adjust their eligibility systems, even though the requirements formally begin on January 1.

The ruling matters for many adults in their 50s and early 60s, who often get coverage through Medicaid expansion while managing serious health problems. People on Medicare are not affected, since the work rules apply only to certain Medicaid enrollees under age 65.