Judge halts strict Medicaid frailty proof rules

A federal judge blocked a new rule that would have required chronically ill Medicaid recipients to prove their conditions prevent them from working.

U.S. District Judge Richard Stearns issued the ruling in Boston on Thursday. The decision partially favors a coalition of 25 states and the District of Columbia. These jurisdictions sued the Trump administration in June over new guidance from the Centers for Medicare and Medicaid Services.

The new guidelines stem from the 2025 law known as the One Big Beautiful Bill. That law defines medically frail individuals to include people with blindness, disabilities, substance use disorders, or serious medical conditions. However, the CMS rule added an extra step. It required these individuals to show that their conditions significantly impair their ability to meet work requirements.

Stearns found that the stricter rule placed an undue burden on state systems. He noted that states face costly and intensive changes to their eligibility verification processes. The judge stated that monetary damages would not adequately compensate for this harm.

The ruling does not eliminate the work requirements themselves. It only strikes down the specific requirement for patients to prove that their medical conditions block their ability to comply. Stearns also upheld two other restrictions. States can still reject medical proof if the diagnosis is older than one year. They can also limit self-attestations to one per continuous enrollment period.

In his 16-page decision, Stearns explained that the government provided a non-frivolous rationale for these remaining provisions. He found that the states' concerns about disenrollment were not compelling enough to overturn those specific parts of the rule.

Representatives from the Department of Health and Human Services and CMS did not immediately respond to a request for comment. The changes affect Medicaid expansion enrollees aged 19 to 64. Under the law, these individuals must work or perform community service for at least 80 hours per month starting January 1. They must also be in school at least half the time to maintain coverage.