Federal Judge Partly Blocks Trump Medicaid Rule On Medically Frail Exemptions
Federal Judge Richard Stearns in Boston on Thursday, October 29, 2026, blocked part of a federal Medicaid guidance that would have required medically frail beneficiaries to prove their conditions impaired their ability to meet work requirements.[1]
Stearns issued a 16-page ruling that partly blocked guidance from the Centers for Medicare & Medicaid Services, but he left the statutory work requirements in place.[1] He barred the rule's requirement that beneficiaries labeled "medically frail" must prove their conditions significantly limit their ability to meet work rules.[1] Stearns did uphold CMS policies that reject medical diagnoses more than a year old and that allow only one self-attestation per continuous enrollment.[1]
A coalition of 25 states and the District of Columbia brought the lawsuit challenging how the "medically frail" exemption is defined and verified.[1] The guidance implements parts of the 2025 "One Big Beautiful Bill," which added work rules for many Medicaid expansion adults starting January 1, 2027.[1]
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📌 Key Facts
- On Thursday, October 29, 2026, Judge Richard Stearns issued a 16-page ruling from Boston partially enjoining a CMS Medicaid guidance.
- The case was brought by a coalition of 25 states and the District of Columbia challenging how "medically frail" exemptions from work requirements are defined and verified.
- Stearns blocked the CMS requirement that medically frail beneficiaries also prove their conditions significantly impair their ability to meet work requirements.
- He left the statutory work requirements in place and upheld CMS policies rejecting diagnoses more than a year old and limiting states to one self-attestation per continuous enrollment.
- The challenged guidance implements parts of the 2025 "One Big Beautiful Bill" that added work rules for many Medicaid expansion adults starting January 1, 2027.
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