Federal judge blocks Medicaid work requirement rule

BOSTON — A federal judge has blocked President Donald Trump’s administration from enforcing a rule that narrowed exceptions to new work requirements for Medicaid recipients with serious medical conditions.

The ruling by U.S. District Judge Richard Stearns in Boston, issued Thursday, sided with Massachusetts and two dozen other states which had sued to block the new rule that sought to force “medically frail” individuals to clear certain hurdles to keep their government-funded health insurance coverage.

Medicaid, the government health insurance program for low-income Americans, is jointly funded by the federal and state governments.

The federal Centers for Medicare & Medicaid Services issued the rule earlier this year to implement work requirements for Medicaid that were mandated as part of Trump’s signature One Big Beautiful Bill Act, a tax cut and domestic policy bill he signed into law last year.

The law requires “able-bodied” adults ages 19 to 64 to complete a minimum of 80 hours of work or community engagement activities per month or be enrolled in education programs at least half time to qualify for Medicaid. Those requirements are set to go into effect on Jan. 1.

The federal agency later provided guidance to Massachusetts and other states about how to implement the work requirements, including the law’s exemptions for people who are “medically frail” or “otherwise have special medical needs.”

But Sterns, a Clinton appointee, said CMS unlawfully limited who qualifies as “medically frail” with exemptions applying only if someone’s “physical, mental, or other behavioral health condition significantly impairs the individual’s ability to comply with the community engagement requirement.”

“Because enforcement of an unlawful definition of ‘medically frail’ may lead to the dis-enrollment of otherwise eligible vulnerable individuals relying on Medicaid coverage for continuity of care, the states (and public) face potential for great hardship in the absence of an injunction,” Stearns wrote in the 16-page ruling.

CMS didn’t immediately respond to a request for comment. It also wasn’t clear if the ruling would be appealed.

Attorney General Andrea Campbell, a Democrat who co-led the June lawsuit challenging the rule, said the judge’s ruling backs her claims that the Trump administration’s attempt “to impose new, burdensome requirements on medically vulnerable Medicaid recipients is unlawful and effectively blocked these harmful rules from taking effect.”

“This victory protects access to healthcare for residents with serious illnesses and disabilities and ensures their care won’t be interrupted due to unlawful red tape,” she said in a statement.

The tax and policy bill signed by President Donald Trump last month cuts federal spending on Medicaid by more than $1 trillion over the next 10 years, leaving states to either make up the difference with their own funds or reduce coverage.

Besides the work requirements, the new law also includes restrictions on coverage for certain immigrants, including stripping Medicaid eligibility from refugees and asylum-seekers.

An estimated 350,000 Bay Staters are at risk of losing their Medicaid coverage under the federal changes, according to the Healey administration.

Health care coverage is one of the state’s biggest expenses. The cost of MassHealth — the state’s Medicaid program which serves more than 2 million or roughly one in every three people — has doubled in the past decade and now accounts for nearly 40% of overall spending.

Christian M. Wade covers Massachusetts state government and politics for CNHI News and North of Boston Media Group’s newspapers and websites. Email him at cwade@cnhinews.com.

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