Judge blocks Trump administration from enforcing new ‘medically frail’ Medicaid rule

The government unlawfully tried to make it harder for vulnerable Medicaid recipients to get exemptions to the program’s work requirement, ruled a federal jurist.(CN) — A federal judge on Thursday found that the Trump administration’s new Medicaid requirement, which narrows the definition of people considered “medically frail,” is unlawful.The new rule drastically narrows the government’s definition of a “medically frail” individual, effectively requiring many vulnerable Medicaid recipients to prove their conditions prevent them from working to continue receiving benefits. In a 16-page order, U.S. District Judge Richard Stearns sided with a coalition of more than two dozen states that sued over the summer, claiming guidance from the Centers for Medicare and Medicaid Services (CMS) took them by surprise.Stearns, a Bill Clinton appointee in the District of Massachusetts, granted summary judgment to the states, blocking the rule from taking effect. He ruled that Congress had already defined what constitutes a “medically frail” individual when it passed the One Big Beautiful Bill Act in 2025, making CMS’ attempt to change that definition “contrary to law.”“It is well-recognized that there is an inherent public interest in ensuring that the government follows the law, and because enforcement of an unlawful definition of ‘medically frail’ may lead to the disenrollment of otherwise eligible vulnerable individuals relying on Medicaid coverage for continuity of care, the states (and public) face potential for great hardship in the absence of an injunction,” Stearns wrote.Congress mandated that the definition of “medically frail” includes people with disabilities, blindness, certain mental disorders or complex medical conditions. The new CMS rule raises the bar, however, requiring those people to also show that their conditions “significantly impair” their ability to comply with Medicaid work requirements. Under the One Big Beautiful Bill Act, those requirements amount to 80 hours per month of employment, volunteering or school.Stearns found that the new definition posed a real risk of vulnerable individuals losing coverage. He also ruled that the states would face financial harm.“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,” he ruled.The ruling does not block the work requirements themselves, only the heightened definition of the “medically frail” exemption. The One Big Beautiful Bill Act’s work requirements are set to take effect nationally in January.New York Attorney General Letitia James, one of the state leaders behind the lawsuit, said Thursday that Stearns’ ruling would prevent vulnerable people from having to jump through hoops to maintain their coverage.“New Yorkers who are living with cancer, a disability, a serious mental health condition, or addiction should never have to prove they are sick enough to keep their health care,” she said in a statement. “The more barriers to coverage there are, the less healthy our communities become. I am pleased to have secured this potentially life-saving relief for some of our most vulnerable New Yorkers.”CMS does not comment on pending litigation. A representative for the Department of Health and Human Services, which oversees CMS, did not immediately respond to a request for comment.Thursday’s ruling comes as states say they are already scrambling to comply with Congress’ new Medicaid work requirements ahead of their implementation in 2027. In their June 29 lawsuit, the states argued that the new definition of medical frailty would make compliance even more difficult.“It will disproportionately hurt people who are already at risk, such as older adults who are not yet eligible for Medicare and people with serious chronic conditions,” they wrote in their complaint from June 29. “Defendants’ action will cause immediate and irreparable harms to plaintiff states’ operation of their state Medicaid programs. It will further strain safety net providers, lead to more uncompensated emergency care, and raise other costs associated with newly uninsured, medically frail residents. And it will cause rural hospitals to be even more likely to shutter.”Subscribe to our free newslettersOur weekly newsletter Closing Arguments offers the latest about ongoing trials, major litigation and rulings in courthouses around the U.S. and the world, while the monthly Under the Lights dishes the legal dirt from Hollywood, sports, Big Tech and the arts.Additional Reads