Judge blocks Trump administration's Medicaid rule forcing sick
recipients to prove frailty
[October 30, 2026]
By FATIMA HUSSEIN
WASHINGTON (AP) — Chronically ill people on Medicaid won't be bound by
new work requirement rules that the latest Trump administration guidance
requires in order to qualify for “medically frail” exemptions, a federal
judge ruled Thursday.
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.”
The law says the definition of medically frail must include people who
are blind or disabled, have substance use disorders or disabling mental
disorders, have certain disabilities that significantly impair daily
activities, or have serious or complex medical conditions. But the CMS
rule went further, requiring people in those categories to show that
their conditions also “significantly impair” their ability to comply
with the law’s work requirements.
The plaintiffs argued that the stricter rule would prevent eligible
Americans from accessing the care they need — and oversteps the text of
the law itself as well.
“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,” Stearns said in his 16-page ruling.
Notably, while the ruling will make it easier for some Medicaid
recipients with qualifying medical conditions to obtain an exemption
from the new work requirements, Stearns' decision does not strike down
the work requirements as unlawful.
It is likely to mean some people will be able to obtain or keep
coverage, said Morgan Henderson, an economist who studies Medicaid at
The Hilltop Institute at the University of Maryland, Baltimore County.
“Those individuals who would have lost coverage because they’re sick but
they’re not quite sick enough,” he said, "they might have their coverage
preserved now.”
North Carolina Health and Human Services Secretary Dev Sangvai said it
would also help patients avoid some stressful situations.
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President Donald Trump talks with reporters after arriving on Air
Force One, Friday, Oct. 23, 2026, at President Donald J. Trump
International Airport in West Palm Beach, Fla., as Health and Human
Services Secretary Robert F. Kennedy Jr. and Centers for Medicare &
Medicaid Services administrator Dr. Mehmet Oz listen. (AP Photo/Mark
Schiefelbein)
 “One of our top priorities is to
make sure people can get the critical health care they need without
facing confusing paperwork or the fear of losing coverage during
treatment," he said in a statement. "This decision allows us to
focus on what matters most: delivering reliable health care to our
state’s most vulnerable residents when they need it most.”
Additionally, Stearns upheld two other federal restrictions on how
states can verify medical frailty, including the requirement that
states reject proof of patients’ medical frailty if the diagnosis is
more than a year old. He also upheld a policy allowing states to
accept only one self-attestation per continuous period of
enrollment.
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."
CMS declined to comment.
The new Medicaid restrictions are part of Trump’s big tax and policy
law in 2025. The change affects those covered through an expansion
in most states that gave more lower-income people access to the
government’s safety net healthcare program.
Starting Jan. 1, expansion enrollees aged 19 to 64 must show that
they work or do community service at least 80 hours a month, or are
in school at least half the time. There are exceptions for those
considered medically frail or in addiction treatment programs, among
others.
___
Associated Press reporter Geoff Mulvihill contributed to this
article from Haddonfield, New Jersey.
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