JUDGE BLOCKS TRUMP'S MEDICAID CRACKDOWN ON THE SICK: “Great Hardship” Warning

U.S. District Judge Richard Stearns in Boston ruled Thursday, October 29, blocking the Trump administration from enforcing a rule that narrowed exemptions to Medicaid's new work requirements for people with serious medical conditions.

The case was brought by 25 states and the District of Columbia, which argued the rule would force medically frail people to clear unnecessary hurdles just to keep their government-funded health coverage.

The work requirements themselves come from the One Big Beautiful Bill Act, signed into law in 2025. Starting January 1, 2027, most Medicaid expansion enrollees ages 19 to 64 must complete at least 80 hours of work or community engagement a month, or be enrolled in school at least half time.

Congress exempted people who are “medically frail or otherwise have special medical needs.” But the Centers for Medicare and Medicaid Services' June rule added a second test: a condition only counted if it “significantly impairs” the person's ability to comply with the work requirement. Stearns ruled that added test unlawful, warning that enforcing it could lead to eligible, vulnerable people being disenrolled.

The ruling was only a partial win for the states. Stearns upheld two other challenged provisions, including a rule barring states from relying on proof of medical frailty more than 12 months old. The work requirements themselves were not struck down, and the January 1 start date stands.