A federal judge maintained a Trump administration regulation requiring “medically frail” Medicaid patients to prove their inability to work to keep their health insurance. This decision follows the Centers for Medicare and Medicaid Services (CMS) decision to proceed with Medicaid work requirements, part of President Trump’s One Big Beautiful Bill Act.
The announcement led to a lawsuit by attorneys general or governors from 24 states with Democratic leadership. Massachusetts Attorney General Andrea Campbell played a leading role, expressing concern that states lack adequate time to adjust their plans or inform members of new requirements.
Despite the legal challenge, a federal judge in Massachusetts refused to suspend the rule, marking a legal victory for the Trump administration. Jake Haselswerdt, a public policy professor, explained the ruling allows CMS to proceed with the proposed rule for now.
States’ Lawsuit Against Medicaid Work Rule
CMS introduced the rule in June, requiring Medicaid recipients to engage in 80 hours of activities like work or community service monthly. While significant exemptions exist for individuals deemed “medically frail,” states sued, arguing the rule’s compliance demands threaten healthcare access for vulnerable individuals.
States allege the rule exceeds the One Big Beautiful Bill Act’s limits, threatening coverage for those with serious medical conditions.
Massachusetts AG Campbell emphasized the rule’s “burdensome” nature and potential healthcare access risks in a statement. The lawsuit highlights concerns about self-attestation limits and renewal timelines, necessitating new IT systems that would incur significant costs and time.
Under the rule, a medically frail person may include individuals with a disabling condition affecting daily activities, blind individuals, or those with severe health conditions.
Impact on Medicaid Patients
Haselswerdt noted the rule could adversely affect patients. He explained that navigating such bureaucratic processes could cause eligible individuals to lose or never obtain benefits, particularly impacting the most vulnerable.
Haselswerdt believes the case has merit, suggesting the medical frailty issue stems from Congress’s existing terminology without new definitions for work requirements.
Judge’s Ruling and Rationale
Federal Judge Richard G. Stearns supported the Trump administration. He stated financial damages due to agency actions suffice to prove irreparable harm and found the states failed to show their expenditures would be unrecoverable.
The judge clarified the timeline originates from Congress, not CMS, and emphasized that the denial of the injunction doesn’t indicate the court’s final stance on the case’s merits.
He noted the case involves challenging issues regarding Congress’s delegation of authority to the Secretary and the judgments underlying the rule. These determinations, he suggested, should occur based on a full record at the summary judgment stage.