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Judge Blocks Trump Admin's Strict Medicaid Work Requirements
Confirmed
In Short: U.S. District Judge Richard Stearns issued a 16-page order blocking the Trump administration's new rule that would have imposed stricter work requirements on Medicaid recipients, siding with a coalition of more than two dozen states.
The new rule, part of the One Big Beautiful Bill Act, mandated 80 hours of employment, volunteering, or school per month for Medicaid eligibility.
Stearns ruled that the Centers for Medicare and Medicaid Services (CMS) had overstepped its authority by changing the definition of 'medically frail,' which Congress had already defined to include people with disabilities, blindness, certain mental disorders, or complex medical conditions.
The judge stated that the states had shown irreparable harm, noting that the rule would force medically frail individuals to clear unnecessary hurdles to maintain their government-funded health insurance.
Stearns emphasized that the rule would cause immediate and irreparable harm to states' Medicaid programs, straining safety net providers and leading to more uncompensated emergency care.
The ruling also highlighted that the rule would raise costs associated with newly uninsured, medically frail residents and increase the likelihood of rural hospitals closing.
CMS had raised the bar for the definition of 'medically frail,' requiring individuals to show that their conditions significantly impair their ability to comply with Medicaid work requirements.
The coalition of states argued that the abrupt changes left them insufficient time to adjust their systems and effectively communicate to members what was required.
Medicaid, a jointly federal-state funded health insurance program for low-income and disabled people, covers nearly 66 million adults and nearly 7.2 million children each year.
Currently, 41 states (including DC) have expanded their Medicaid programs under the ACA to nearly all adults with income up to 138% FPL ($21,597 for an individual in 2025).
The 2025 reconciliation law, once called the “One Big Beautiful Bill,” signed by President Trump on July 4, 2025, requires 44 states (including DC) to condition Medicaid eligibility for adults in the ACA Medicaid expansion group and certain enrollees in 1115 waiver programs on meeting work requirements starting January 1, 2027.
What this adds
The ruling underscores the ongoing debate over Medicaid work requirements and their impact on vulnerable populations.
What's confirmed
- Congress mandated that the definition of “medically frail” includes people with disabilities, blindness, certain mental disorders or complex medical conditions.
- “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.
- “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.
- 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.
- U.S. District Judge Richard Stearns in Boston sided with 25 states and the District of Columbia, which had argued that the new rule would force medically frail people to clear unnecessary hurdles to maintain government-funded health insurance coverage.
- U.S. District Judge Richard Stearns in Boston gave a partial victory to a coalition of 25 states and the District of Columbia, which sued the Trump administration in June over the new Centers for Medicare and Medicaid Services guidance linked to the 2025 law known as the "One Big Beautiful Bill."
What's still developing
- Work requirements for Medicaid are a longstanding Republican policy initiative.
- As I previously reported, the rule released near the beginning of June was even more onerous than many state officials feared.
- A federal judge on Thursday blocked President Donald Trump's administration from enforcing a rule that would narrow exceptions to new work requirements for Medicaid recipients with serious medical conditions.
- Last month, Jackson joined attorneys general from 23 other states and the governors of Kentucky and Pennsylvania in a lawsuit challenging new guidance issued by the Centers for Medicare and Medicaid Services.
- Congress included an exemption in last year’s federal Medicaid work requirement law for people who are “medically frail” — a category that encompasses people with serious or complex medical conditions like cancer, Parkinson’s disease, cystic fibrosis and other illnesses that can make it difficult to maintain employment.
- Explaining why he upheld the portions in favor of the government, Stearns said "the government provided a non-frivolous rationale for adopting each provision and explained why it did not find the States' concerns of disenrollment compelling." Representatives from the Department of Health and Human Services and CMS did not immediately respond to an Associated Press request for comment.
- A federal judge on Thursday thwarted the Trump administration from enforcing a rule that would impose a strict version of work requirements for Medicaid recipients battling illness.
- "Today's decision is a victory for patients as it strikes back against unnecessary barriers to car," American Medical Association President Willie Underwood said in a statement.
- After the initial post got millions of views, Huckabee Sanders followed up with an X post that said, "Some critics online don't like my welfare work requirement ad. Next thing you know they’ll say I should have used cookies instead of cheese balls."
- The ad, released as Huckabee Sanders runs for reelection on new welfare work requirements, follows a fictional character named "Brad," who is portrayed as an able-bodied White man spending his days playing video games, lounging on the couch and avoiding work while relying on taxpayer-funded benefits.
- State’s Chaotic Rollout Foreshadows Risks as Nationwide Deadline Draws Near (Washington, DC) – Nebraska’s efforts to implement new, federally mandated work requirements for Medicaid underscore fears that millions of people will experience avoidable barriers to healthcare coverage, Human Rights Watch, Oxfam America, and Nebraska Appleseed said today.
- Eli McCreary, age 64 at the time, said he lost his Medicaid coverage while undergoing treatment for kidney cancer and multiple chronic health conditions.