A federal judge has upheld a Trump administration rule requiring “medically frail” Medicaid recipients to verify their inability to work to retain health insurance. This stems from the Centers for Medicare and Medicaid Services (CMS) moving forward with Medicaid work requirements within President Donald Trump’s One Big Beautiful Bill Act, prompting a lawsuit from 24 states with Democratic attorneys general or governors.
The legal challenge could have significant effects on the approximately 67 million Americans covered by Medicaid. Massachusetts Attorney General Andrea Campbell, a leader in the lawsuit, criticized the rule, stating it doesn’t provide states ample time to adapt or effectively inform members about the new requirements.
Despite the legal challenge, a federal judge in Massachusetts declined to prevent the rule’s enforcement as legal proceedings continue, supporting the Trump administration amid broader legal setbacks. Jake Haselswerdt, a University of Missouri public policy professor, noted that CMS can proceed with the rule.
Reasons Behind the States’ Lawsuit
CMS introduced the rule in June, requiring Medicaid beneficiaries engaged in qualifying activities like work, education, or community service for at least 80 hours monthly. Exceptions exist for those deemed “medically frail” if physical conditions impact compliance.
Noncompliant states must issue notices, allowing individuals 30 days to demonstrate compliance or exemption. Failure results in loss of Medicaid coverage. States must enact this rule by January 1, 2027.
Campbell argued that the rule burdens vulnerable residents and risks healthcare access. Congress, she wrote, intended coverage protection for those with serious medical issues. The lawsuit claims the rule exceeds the intended scope of Trump’s bill.
The lawsuit highlights concerns about self-attestation and renewal timelines. States may need new IT systems by January 1, incurring substantial expenses, according to the suit.
Medically frail individuals must have a condition hampering their requirement compliance. These could include disabilities, certain mental health disorders, and serious health conditions.
Implications for Medicaid Patients
Haselswerdt explained that navigating bureaucratic processes could cause eligible individuals to lose benefits. The more vulnerable, such as those with unstable living conditions or health issues, face higher risks of complications.
He believes the case has merit regarding the medical frailty definition, as Congress did not explicitly alter its meaning for work requirements. He views the administration’s interpretation as a significant leap.
Judge’s Ruling Details
Judge Richard G. Stearns favored the Trump administration, stating financial damages do not establish irreparable harm. He was unconvinced by states’ claims of unrecoverable expenses, attributing the timeline to Congress.
Stearns noted his denial isn’t a reflection on the underlying litigation, which involves complex issues about Congressional intent and authority delegation. He suggested further examination of supporting data and medical judgments.