A federal judge chose not to block a Trump administration rule requiring ‘medically frail’ Medicaid recipients to demonstrate their inability to work to retain their health insurance. The Centers for Medicare and Medicaid Services (CMS) faced a lawsuit from 24 states led by Democratic attorneys general or governors in response to implementing these work requirements. This legal challenge may affect the 67 million Americans enrolled in Medicaid.
State Opposition to Medicaid Work Rule
The lawsuit argued that the rule was more restrictive than the One Big Beautiful Bill Act—President Trump’s notable legislation—intended. Massachusetts Attorney General Andrea Campbell criticized the rule, saying states lack sufficient time to adjust plans or effectively inform Medicaid members about the new requirements.
A federal judge in Massachusetts did not block the rule while the lawsuit proceeds through court. Jake Haselswerdt, a public policy professor, remarked to Newsweek that CMS can continue with the proposed rule temporarily. Newsweek contacted Campbell and CMS for further comments.
Medicaid Work Rule Details
Announced in June by CMS, the rule requires ‘applicable individuals’ on Medicaid to partake in at least 80 hours of qualifying activities monthly. These activities may include work, educational programs, community service, or work programs. Exemptions exist for those deemed ‘medically frail’ due to physical conditions impairing their ability to fulfill requirements.
States failing to verify compliance must issue notices of noncompliance, giving individuals 30 days to prove compliance or qualify for an exception. Failure to comply results in losing Medicaid coverage. The rule mandates implementation by January 1, 2027.
Campbell’s June statement branded the requirements as ‘burdensome,’ potentially restricting healthcare access for vulnerable residents. The lawsuit highlighted risks for people with disabilities, cancer patients, or those with severe health conditions.
Concerns also included limits on self-attestation and renewal timelines, requiring states to develop new IT systems and processes by January 1. The lawsuit claimed these requirements demanded significant resources and personnel.
Impact on Medicaid Patients
Haselswerdt explained the potential effects of the rule on patients. Policymaking that introduces hurdles and bureaucracy may result in eligible individuals failing to obtain or retain benefits. Vulnerable populations—due to poverty, unstable housing, or chronic health issues—might struggle to navigate these processes.
He also noted that the legal challenge has merit, considering Congress did not redefine ‘medically frail’ from its original context. His view suggests that redefining these terms by the administration appears excessive.
Why Judge Supports Trump Administration
The judge’s decision favored the Trump administration. Judge Richard G. Stearns noted that financial damages from agency actions could establish irreparable harm. He was unconvinced by states’ claims that their expenditures are unrecoverable.
The judge emphasized that the timeline was determined by Congress, not the CMS. He clarified that the court’s decision was not reflective of its final judgment on the lawsuit’s merits. Stearns pointed out the necessity for a comprehensive examination of data and decisions made by the Secretary of Health and Human Services.
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