Federal judge blocks Trump administration's narrower 'medically frail' definition in Medicaid work requirement rule

A federal judge in Boston on Thursday 29 October blocked the Trump administration from enforcing part of a rule that sets out which Medicaid recipients count as “medically frail” and are therefore exempt from new work requirements, Reuters reported.

US District Judge Richard Stearns sided with 25 states and the District of Columbia, led by the attorneys general of California, Massachusetts and New Jersey. The states argued that the rule would force medically frail people to clear unnecessary hurdles to keep their health coverage.

The Centers for Medicare & Medicaid Services (CMS) issued the rule in June to implement work requirements included in the One Big Beautiful Bill Act, which President Donald Trump signed into law last year. From 1 January, the law requires most adults aged 19 to 64 to complete at least 80 hours a month of work or community engagement, or to be enrolled in education at least half time, to qualify for Medicaid.

The rule said the frailty exemption applies only if a person’s health condition “significantly impairs” their ability to meet the requirement. Stearns ruled that this definition unlawfully narrowed the exemption written into the law. “Enforcement of an unlawful definition of ‘medically frail’ may lead to the disenrollment of otherwise eligible vulnerable individuals,” he wrote.

The judge upheld other provisions of the rule that the states had also challenged, and the work requirements themselves remain in place, according to Reuters and AP. CMS did not immediately respond to a request for comment, Reuters reported.