Judge blocks added Medicaid frailty test for work requirement exemptions

A federal judge in Boston ruled Thursday that CMS cannot require Medicaid recipients who fit listed medically frail categories to also prove their conditions significantly impair their ability to comply with work requirements. Judge Richard Stearns ruled for a coalition of 25 states and the District of Columbia, which challenged the guidance tied to the 2025 law known as the One Big Beautiful Bill.

The law’s categories include people who are blind or disabled, have substance use disorders or disabling mental disorders, certain disabilities that significantly impair daily activities, or serious or complex medical conditions. Stearns did not strike down the work requirements. He upheld rules requiring states to reject diagnoses more than a year old and allowing one self-attestation per continuous enrollment period. Starting Jan. 1, expansion enrollees ages 19 to 64 must work or do community service at least 80 hours a month, or attend school at least half the time, with exceptions including medically frail recipients.