Judge halts Trump admin rule requiring 80-hour work proof for Medicaid

A federal judge blocked a new administration rule on Thursday that required chronically ill Medicaid recipients to prove their conditions were severe enough to prevent them from working. U.S. District Judge Richard Stearns ruled against enforcing the regulation, which targeted low-income individuals enrolled in the public health insurance program.

The legal battle began in June when 25 states and the District of Columbia filed suit against the Trump administration. The plaintiffs argued the new rule unlawfully narrowed the definition of "medically frail" people who qualify for exemptions from work mandates. Federal law already defines medical frailty to include individuals who are blind, disabled, have substance use disorders, or suffer from serious complex conditions.

The administration’s proposal added a second layer of scrutiny. It required individuals in those protected categories to demonstrate that their conditions also "significantly impair" their ability to meet the law’s work requirements. The suing states contended this extra step would bar eligible Americans from accessing necessary care and went beyond the text of existing legislation.

Stearns, a Clinton appointee serving in the District of Massachusetts, issued a 16-page decision in favor of the states. He found that the plaintiffs showed irreparable harm because the new rule forced them to make costly changes to their eligibility verification systems. "They face the burden of costly and intensive alterations to their eligibility verification systems," Stearns wrote. The Centers for Medicare & Medicaid Services, the agency that adopted the rule, declined to comment on the decision.

The work requirements themselves remain in effect. Starting January 1, 2027, Medicaid expansion enrollees between the ages of 19 and 64 must work or perform community service for at least 80 hours a month or attend school at least half the time. Exceptions exist for those in addiction treatment or those deemed medically frail under the standard definition upheld by the court.

The ruling does not strike down the work mandates as unlawful. It only removes the stricter interpretation of medical frailty. Stearns also upheld two other federal restrictions on how states verify medical conditions, which the states had previously contested.

The decision affects millions of low-income Americans who rely on Medicaid for coverage. The program is funded jointly by state and federal governments. The court’s move simplifies the process for patients with qualifying medical conditions to obtain their exemptions without proving a specific level of functional impairment.