A federal judge on Thursday blocked the Trump administration from enforcing a rule that would have limited the types of medical conditions that exempt Medicaid recipients from new work requirements. U.S. District Judge Richard Stearns in Boston issued the injunction in a lawsuit brought by 25 states and the District of Columbia. The ruling prevents the government from narrowing the definition of "medically frail" individuals who are excused from the program’s labor mandates.
The disputed rule was issued in June 2026 by the U.S. Centers for Medicare & Medicaid Services (CMS). It was designed to implement work requirements established by the One Big Beautiful Bill Act, a tax and spending law signed by President Donald Trump last year. Under that law, most Medicaid recipients aged 19 to 64 must complete 80 hours of work, community service, or half-time education per month to remain eligible for coverage.
Judge Stearns ruled that CMS unlawfully restricted the "medically frail" exemption by requiring that a person’s condition "significantly impairs" their ability to work before they can qualify for a waiver. The judge wrote that enforcing this definition could cause "great hardship" by disenrolling vulnerable people who rely on Medicaid for continuous medical care. While Stearns blocked the definition, he upheld other parts of the rule, including a provision that prevents states from using medical evidence that is more than 12 months old to prove a recipient's frailty.
For a Medicaid household, the impact of the rule would have been felt in the administrative process required to maintain coverage. Instead of a standard medical exemption, recipients would have needed to meet the more stringent "significantly impairs" threshold or document 80 hours of monthly community engagement. The 25 states argued that this would have created "unnecessary hurdles" for the medically frail to maintain their insurance. The judge's decision maintains a broader path for these individuals to keep their government-funded health care without meeting the labor quotas.
The case sets a legal precedent regarding how much authority federal agencies have to define statutory terms like "medically frail" when implementing laws passed by Congress. California Attorney General Rob Bonta stated that the administration's narrowed definition was "not what Congress intended." While the CMS declined to comment on the ruling, the agency's next steps regarding a potential appeal or a revised rule remain unknown. The underlying work requirements themselves are currently scheduled to take effect on January 1, 2027.