US District Judge Richard Stearns sided with 25 states and the District of Columbia which sued the administration.
Published On 30 Oct 2026
A federal judge has ruled against enforcing a new rule by the administration of US President Donald Trump that would require chronically ill people on Medicaid, a public health insurance programme for low-income individuals, to prove themselves “medically frail” to qualify for work exemptions.
US District Judge Richard Stearns blocked the rule on Thursday, siding with 25 states and the District of Columbia, which had sued the Trump administration in June over the change, arguing that it unlawfully limits exemptions for people with serious medical conditions.
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The law says the definition of medically frail must include people who are blind or disabled, have substance use disorders or disabling mental disorders, have certain disabilities that significantly impair daily activities, or have serious or complex medical conditions.
‘Significantly impair’ abilities
But the administration’s rule went further, requiring people in those categories to show that their conditions also “significantly impair” their ability to comply with the law’s work requirements.
The plaintiffs argued that the stricter rule would prevent eligible Americans from accessing the care they need, and that it oversteps the law’s text.
“The states have met their burden of showing irreparable harm for which monetary damages would provide inadequate compensation – they face the burden of costly and intensive alterations to their eligibility verification systems,” Stearns said in his 16-page ruling.
The Centers for Medicare & Medicaid Services, the agency that adopted the rule, declined to comment.
Medicaid is a public health insurance programme for low-income people, funded by state and federal governments.
Two restrictions upheld
Starting January 1, 2027, Medicaid expansion enrollees aged 19 to 64 must show that they work or do community service at least 80 hours a month, or are in school at least half the time. There are exceptions for those considered medically frail or in addiction treatment programmes, among others.
Notably, while the ruling will make it easier for some Medicaid recipients with qualifying medical conditions to obtain an exemption from the new work requirements, Stearns’s decision does not strike down the work requirements as unlawful.
Stearns serves in the District of Massachusetts and was appointed by President Bill Clinton.
His ruling upheld two other federal restrictions on how states can verify medical frailty that the states and the District of Columbia had also contested.
