Daijiworld Media Network - Washington
Washington, Oct 30: A federal judge has blocked a Trump administration rule that sought to impose stricter conditions on chronically ill and disabled people seeking exemptions from new work requirements under the Medicaid health insurance programme.
US District Judge Richard Stearns, based in Boston, ruled on Thursday in favour of a coalition of 25 states and the District of Columbia, which challenged the administration's policy, arguing that it unlawfully narrowed the category of people eligible for medical exemptions.
The dispute centres on the definition of "medically frail" under the 2025 law known as the One Big Beautiful Bill Act. The legislation includes people who are blind or disabled, have substance use disorders or disabling mental health conditions, have certain disabilities that significantly affect daily activities, or suffer from serious or complex medical conditions.
However, guidance issued by the Centers for Medicare & Medicaid Services (CMS) imposed an additional condition, requiring individuals in these categories to demonstrate that their medical conditions also significantly impaired their ability to meet the new work requirements.
The states argued that this interpretation went beyond what Congress had specified in the law and could prevent eligible people from retaining access to essential healthcare.
In his 16-page ruling, Stearns said the states had demonstrated irreparable harm, pointing to the costly and extensive changes they would have to make to their eligibility verification systems. He also warned that enforcing the narrower definition could result in vulnerable individuals losing Medicaid coverage and disrupting their continuity of medical care.
The ruling provides relief to people with qualifying medical conditions by preventing the administration from enforcing the additional work-related impairment test when determining medical frailty exemptions.
However, the judge did not strike down the Medicaid work requirements themselves. The legislation requires most Medicaid expansion beneficiaries aged 19 to 64 to complete at least 80 hours of work or community service each month, or attend an educational programme at least half-time, to retain eligibility.
The requirements are scheduled to take effect on January 1, 2027. Exemptions are available for people considered medically frail, individuals undergoing addiction treatment and certain other categories.
Stearns also upheld two other federal restrictions challenged by the states. These include a requirement that states reject medical evidence of frailty if the diagnosis is more than 12 months old and a provision limiting individuals to one self-attestation during each continuous period of enrolment.
The judge said the administration had provided a reasonable basis for adopting those two provisions.
The lawsuit was filed in June by 25 states and the District of Columbia against the administration's guidance implementing the new Medicaid rules. The CMS, which issued the contested guidance, did not immediately comment on the ruling.
Medicaid is jointly funded by the federal and state governments and provides health insurance to millions of low-income Americans. The new work requirements form part of the sweeping changes introduced under the 2025 legislation.
Stearns, who serves on the US District Court for the District of Massachusetts, was appointed to the federal bench by former president Bill Clinton.