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.
The Trump administration, Judge Stearns concluded, had unlawfully winnowed down who fits into each of those groups by layering on the requirement that they also be too sick to work.
The federal government “lacked authority to exclude any subset of individuals in the five subcategories delineated as ‘medically frail’ by Congress,” Judge Stearns wrote, noting that the Trump administration’s rule could “lead to the disenrollment of otherwise eligible vulnerable individuals relying on Medicaid.”
A spokeswoman for the Centers for Medicare and Medicaid Services did not immediately respond to a question about whether the administrations planned to appeal.
Attorneys general of the states who brought the lawsuit expressed relief over the ruling.
“Today’s decision is a major victory that ensures that some of our most vulnerable residents are able to continue to access the health care they deserve,” said Rob Bonta, California’s attorney general and one of the plaintiffs.
Even with the new ruling, the Medicaid work requirement is still expected to lead to significant losses in coverage. The nonpartisan Congressional Budget Office estimated that, based on the original law, around five million people would become uninsured because of the work requirement, including many people who were working but unable to handle the paperwork to prove it. Medicaid covers about 66 million Americans who are poor or disabled.
States have been racing to prepare for the new law by the end of the year. They must build systems to evaluate who qualifies for the law’s exceptions, and to measure the work hours of those who do not.
Before the regulation was published, many had been preparing lists of serious health conditions that could be automatically matched with applicants’ medical records.
Nebraska and Montana have enacted their work requirements early.
In addition to the District of Columbia, the states that brought the lawsuit were Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia, Washington and Wisconsin.
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