Federal Judge Halts Medicaid Frailty Proof Requirement
A Boston court ruled that sick Medicaid recipients do not need to prove their conditions prevent them from working under new federal rules.
By Fatima Saleh ·
Chronically ill individuals enrolled in Medicaid will not be forced to prove their conditions prevent them from working, a federal judge in Boston ruled on Thursday. The decision partially blocks new guidance from the Trump administration that tightened the definition of medical frailty under the 2025 One Big Beautiful Bill.
U.S. District Judge Richard Stearns issued the ruling in favor of a coalition of 25 states and the District of Columbia. The group filed a lawsuit in June against the Centers for Medicare and Medicaid Services. They argued the new rules went beyond the text of the law by requiring patients to show that their specific conditions significantly impair their ability to meet work requirements.
The law defines medical frailty to include people who are blind or disabled, have substance use disorders, or have serious complex medical conditions. However, the CMS rule added an extra layer. It required individuals in these categories to demonstrate that their conditions also hinder their capacity to comply with work mandates. Stearns wrote that the states showed they would suffer irreparable harm. He noted that they face the cost of making intensive alterations to their eligibility verification systems.
The ruling does not eliminate the new work requirements entirely. Instead, it makes it easier for some recipients to obtain an exemption. Stearns upheld two other restrictions on how states verify medical frailty. He kept the rule that states must reject proof of frailty if the diagnosis is older than one year. He also maintained the policy allowing states to accept only one self-attestation per continuous period of enrollment. Stearns explained that the government provided a non-frivolous rationale for these specific provisions.
The changes are part of a larger federal tax and policy law passed in 2025. They affect people covered through Medicaid expansion in most states. Under the new rules, expansion enrollees aged 19 to 64 must show they work or do community service at least 80 hours a month. Alternatively, they must be in school at least half the time. Exceptions exist for those considered medically frail or in addiction treatment programs.
Representatives from the Department of Health and Human Services and CMS did not immediately respond to a request for comment. The new requirements start on January 1. Until then, the court order keeps the stricter proof of impairment requirement on hold.
Source: KOB
