Federal judge blocks Trump Medicaid work-requirement rule for medically frail recipients

U.S. District Judge Richard Stearns ruled that the Trump administration’s new Medicaid requirement is unlawful. The rule narrowed the definition of “medically frail,” forcing many vulnerable recipients to prove their conditions prevent them from working to keep benefits.

Stearns granted summary judgment to more than two dozen states that sued over the summer. He said Congress already defined “medically frail” when it passed the One Big Beautiful Bill Act in 2025, making the Centers for Medicare and Medicaid Services attempt to change that definition contrary to law.

“It is well-recognized that there is an inherent public interest in ensuring that the government follows the law.”

Congress mandated that the definition include people with disabilities, blindness, certain mental disorders, or complex medical conditions. The new CMS rule raised the bar by requiring those people to also show their conditions “significantly impair” their ability to comply with Medicaid work requirements.

Under the One Big Beautiful Bill Act, those requirements amount to 80 hours per month of employment, volunteering, or school. Stearns found the new definition posed a real risk of vulnerable individuals losing coverage and that states would face financial harm.

States faced a tight deadline to stand up the work requirement program by January 1. The medically frail interpretation required additional changes, and the ruling will force them to shift directions again.

Advocates worried the rule would add major paperwork burdens to patients and put doctors in a tough spot by asking them to determine whether someone is able to work.