Court Blocks Strict New Rule for Medicaid Work Requirements

A federal judge on Thursday told the Trump administration that it could not move forward with a plan that would make it harder for seriously ill Americans to obtain or stay on Medicaid after work requirements take effect in January.

The ruling will apply in 25 states and the District Columbia, all of which sued to challenge the policy. Those states and Washington, D.C., which are led by Democrats, will now be free from penalties for any mistakes they make in determining who is too sick to be required to work.

The work requirement was enacted in the summer of 2025 as part of Republicans’ major tax and domestic policy legislation. It requires poor adults without disabilities to prove they worked, volunteered or attended school at least 80 hours a month in order to qualify for Medicaid or to keep their eligibility for the program.

The law created several exemptions from the work requirement, including one that said people who are “medically frail” would not have to meet the requirement to keep their coverage.

The Trump administration had chosen to interpret the exception very strictly. In June, the Centers for Medicare and Medicaid Services issued a regulation saying a Medicaid recipient would need to offer not just proof of a serious medical condition, such as cancer or H.I.V., but evidence that the illness would “significantly impair” the person’s ability to work.

Judge Richard G. Stearns of the U.S. District Court in Massachusetts found that the Trump administration’s narrow definition of medically frail did not follow the law, which listed five groups of people as medically frail, including those who are blind, have a disabling mental disorder, or have another complex medical condition.