Federal Judge Blocks Part of Medicaid Work Rule That Narrowed Who Counts as Medically Frail

U.S. District Judge Richard D. Stearns of the District of Massachusetts has blocked the Trump administration from enforcing the Centers for Medicare and Medicaid Services definition of "medically frail" in 25 states and the District of Columbia, finding it overly restrictive and potentially harmful to vulnerable enrollees.

The ruling arose from Commonwealth of Massachusetts v. Oz, a case brought by 25 state attorneys general and the District of Columbia challenging the Medicaid work requirements regulation issued under the 2025 federal law commonly called the One Big Beautiful Bill. That law imposed, for the first time at the federal level, community engagement requirements for most working-age Medicaid enrollees. The law exempts people classified as medically frail. CMS's implementing rule, however, narrowed that exemption in ways the plaintiff states said went beyond what the statute allows.

Judge Stearns agreed, ruling that enforcement of the definition would cause "irreparable harm" and could lead to the "disenrollment of otherwise eligible vulnerable individuals relying on Medicaid coverage for continuity of care." The injunction applies only to the 26 plaintiff jurisdictions. Medicaid enrollees in states that did not join the lawsuit remain subject to the full rule, and the administration is expected to appeal.

The ruling carries weight for Medicare because a significant share of Medicare beneficiaries are also enrolled in Medicaid. These dual-eligible individuals rely on Medicaid to cover Medicare cost-sharing, certain premiums, and services that Medicare does not pay for on its own. A Medicaid disenrollment triggered by an unlawfully narrow frailty standard would therefore also strip those individuals of their Medicare financial protections. The Medicare Rights Center, which tracks Medicare consumer issues, flagged the ruling as a development of direct concern to the Medicare population.