ByAndrew Stanton
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A federal judge left in place a Trump administration rule mandating that “medically frail” patients on Medicaid prove they cannot work to maintain their health insurance
The Centers for Medicare and Medicaid Services (CMS) sparked a lawsuit from two dozen states with Democratic attorneys general or governors after moving to implement Medicaid work requirements included in President Donald Trump’s signature legislation, the One Big Beautiful Bill Act. The lawsuit could have major implications for many of the 67 million Americans enrolled in Medicaid
Massachusetts Attorney General Andrea Campbell co-led the lawsuit, writing in a statement that the changes “leave states insufficient time to adjust their implementation plans or effectively communicate to members what is required to navigate the new requirements.”
However, a federal judge in Massachusetts on Wednesday declined to block the rule from taking effect as the challenge makes its way through the court, giving a legal win to the Trump administration as much of its agenda has stalled in courts
Jake Haselswerdt, a professor of public policy at the University of Missouri, told Newsweekthat the ruling means CMS “can go ahead with the proposed rule for now.”
Newsweekreached out to Campbell’s office and CMS for comment
Why States Sued Trump Admin Over Medicaid Work Rule
CMS announced the rule in June. The rule mandates that “applicable individuals” on Medicaid must engage in at least 80 hours of a qualifying activity each month, including work or community engagement, such as educational programs, community service or work programs
There are broad exemptions to the rule, including those who are deemed to be “medically frail,” having physical conditions that would impair their ability to comply
…
If a state cannot verify that an individual has met those requirements, they must issue a notice of noncompliance. The individual would have 30 days to provide proof of compliance or an exception. If they fail to do so, they would lose their Medicaid coverage under the rule
States are required to implement this requirement no later than January 1, 2027
Campbell wrote in a June 29 statement that the requirements are “burdensome” and “threatens access to healthcare for our most vulnerable residents and families.”
“Congress made clear that people with serious medical conditions should not lose coverage,” she wrote. “We are asking the court to block these unlawful provisions to protect Medicaid recipients and prevent needless strain on Massachusetts’ healthcare system.”
The lawsuit argued that the rule goes further than the One Big Beautiful Bill Act allows
“People with disabilities, patients in the middle of cancer treatment, or those struggling with another serious or complex health condition, shouldn’t be at risk of losing the care that helps maintain their health. Nowhere in H.R. 1 does Congress state that individuals’ ability to work must be impaired in order to be “medically frail or otherwise have special medical needs,” or to have a “serious or complex medical condition,” the lawsuit reads
It also raised concerns about limits of self-attestation and renewal timelines. The lawsuit said states would have to build new IT systems and processes by January 1 or risk penalties; doing so would cost states significant staff time and money, the suit claims
Under the rule, patients who are “medically frail” must have a physical, mental or other condition significantly impairing their ability to comply with the requirements. This can include individuals who are blind or disabled, certain individuals with a substance use disability, individuals with a disabling mental disability, individuals with a disability impairing their ability to perform activities of daily living and individuals with a serious or complex medical condition
What Does Medicaid Rule Mean for Patients?
Haselswerdt explained the impact this rule could have on patients
“Whenever you require people to deal with burdens and red tape, a lot of people are going to lose benefits or fail to get benefits in the first place even if they are eligible under the law. The more vulnerable someone is—because they’re poor or don’t have a stable address or have a chronic mental or physical health problem—the harder it is for them to navigate these processes, and the more likely they are to fall through the cracks,” he said
The case, he said, does have merit in his view
“On this specific medical frailty issue, I think they have a case because Congress used this existing terminology (medically frail) and did not specify that it meant something different than it does in the context of alternative benefit plans. It seems like a leap for the administration to decide the words must mean something different for the purposes of the work requirement,” he said
Why Judge Rules Against Trump Admin Challenge
Judge Richard G. Stearns on Wednesday ruled in favor of the Trump administration in the case
He wrote that courts within the districts have recognized that unrecoverable financial damages resulting from agency action are “sufficient” to establish irreparable harm, and the court is “not convinced” that the states “have shown that their expenditures are likely to be totally irrecoverable.”
“To the extent that the States attempt to premise irreparability on the 10% of costs not already subject to reimbursement, the court is not persuaded. The States’ main complaint associated with these costs is the ‘tight timeline[],’ Mem. at 17, under which they must implement the programmatic changes,” he wrote in the ruling. “But it is not clear how much this harm can fairly be attributed to CMS.”
The timeline, he wrote, was set by Congress—not CMS
The judge noted that the court’s denial is not a “reflection or anticipation of its ultimate views on the merits of the underlying litigation.” The cause presents “difficult issues” regarding the scope of Congress’ “delegation of interpretative authority to the Secretary and the faithfulness to Congressional intent with which the Secretary performed his task,” he wrote
“This, in turn, requires an examination of the data relied upon by the Secretary and the judgments (some medical) that underlay his amplification of Congress’s legislative outline. These are determinations that, in the view of the court, should be made on a developed record of the kind that informs a court’s decision at the summary judgment stage of a case,” he wrote
Contact Newsweek editors on this story: Gabe Whisnant and Sam Wilson
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