A federal judge on Thursday, October 29, 2026, blocked a Trump administration rule that would have made it harder for people with serious illnesses and disabilities to qualify for exemptions from new Medicaid work requirements, finding that the restriction could cause eligible Americans to lose health coverage and disrupt ongoing care.
U.S. District Judge Richard Stearns in Boston sided with 25 states and the District of Columbia, striking down a requirement that medically vulnerable recipients prove their conditions significantly impaired their ability to work, attend school or perform community service.
The ruling does not block the broader Medicaid work requirements, which are still scheduled to take effect January 1, 2027. Stearns issued a permanent injunction against the narrower medical-frailty definition and gave the plaintiff states six months of additional protection from enforcement as they update their eligibility systems and address potential errors or delays.
The work requirements, enacted under the tax and spending law President Donald Trump signed in July 2025, generally require certain Medicaid recipients ages 19 to 64 to complete at least 80 hours of work or community service each month, or attend school at least half-time, to maintain coverage.
Congress exempted several groups from those obligations, including people who are blind or disabled, have substance use disorders, disabling mental disorders or serious or complex medical conditions.
The Centers for Medicare & Medicaid Services, led by Administrator Mehmet Oz, added another condition in June. Under the agency’s rule, people seeking medical-frailty exemptions also had to show that their conditions significantly interfered with their ability to satisfy the work requirements.
Massachusetts and 24 other states, along with Washington, D.C., sued on June 29, arguing that the additional test exceeded the agency’s authority and could force people who already qualify for an exemption through extra documentation requirements to preserve their Medicaid coverage.
Stearns agreed that Congress had already identified categories of people who must be included within the medical-frailty exemption. His 16-page opinion found that federal officials lacked authority to narrow those categories by adding another impairment test.
The judge pointed to an important distinction in the law. Congress specifically required certain physical, intellectual or developmental disabilities to significantly impair activities of daily living. It did not include the same additional requirement for people with serious or complex medical conditions.
Stearns also found that enforcing the narrower definition could lead to eligible people losing Medicaid coverage and interrupt continuity of care. The states, he said, also faced costly and extensive changes to their eligibility systems if the rule remained in effect.
The administration prevailed on two other contested provisions. Stearns upheld a 12-month limit on the medical claims and treatment records states can use to verify medical frailty, along with a restriction allowing recipients to certify their own medical status only once during each continuous enrollment period.
Federal officials argued that older medical records may no longer accurately reflect a person’s current condition and that verification safeguards were necessary to administer the exemptions. Stearns found that CMS had provided an adequate justification for both requirements.
The six-month enforcement relief gives the 25 states and Washington, D.C., additional time to adjust their Medicaid eligibility procedures without being penalized for certain errors or delays tied to medical-frailty determinations during the initial rollout.
The decision makes it easier for some people with qualifying illnesses and disabilities to obtain exemptions from the new Medicaid work requirements, but it leaves the broader federal mandate intact. Unless further court action changes the timeline, the remaining requirements are still scheduled to take effect on January 1, 2027.
