A federal judge has blocked part of the Trump administration’s new Medicaid guidance, ruling that chronically ill recipients cannot be required to prove their conditions also prevent them from complying with federal work requirements before they can qualify for a medical exemption.
The decision came Thursday from U.S. District Judge Richard Stearns in Boston in a lawsuit brought by 25 states and the District of Columbia. Nebraska is identified as an early test of the stricter Medicaid work requirements linked to the 2025 federal law known as the “One Big Beautiful Bill.”
The law requires the federal definition of “medically frail” to include people who are blind or disabled, have substance use disorders or disabling mental disorders, have disabilities that significantly limit daily activities or have serious or complex medical conditions. The Centers for Medicare and Medicaid Services added another condition: People in those categories would also have to show that their conditions significantly impair their ability to meet the law’s work requirements.
The states argued that the additional condition went beyond the law and could prevent eligible people from receiving Medicaid coverage. They also challenged the administrative burden of changing eligibility systems to carry out the new requirements.
Stearns’ ruling provides a partial victory to the states. It prevents the administration from enforcing the added requirement for people seeking a medical-frailty exemption, making it easier for some Medicaid recipients with qualifying conditions to obtain an exemption.
The ruling does not invalidate the Medicaid work requirements themselves. Stearns also upheld federal restrictions governing how states verify medical frailty, including a requirement that states reject proof based on a diagnosis more than one year old.
What the ruling addresses
- The court blocked the added requirement tying a person’s medical condition to the ability to comply with Medicaid work rules.
- The decision leaves the broader work requirements in place.
- The court upheld the one-year limit on diagnoses used to verify medical frailty.
The case concerns federal guidance issued by CMS under the 2025 law. The ruling addresses how states must determine whether Medicaid recipients qualify for an exemption because of medical conditions while the broader eligibility changes move forward.
