A US federal judge on October 29 struck down an added restriction on medical exemptions from Medicaid work requirements, easing a barrier to health coverage for people with serious conditions. Judge Richard Stearns in Boston ruled that the Centers for Medicare & Medicaid Services exceeded its authority, according to court documents and Associated Press reporting.
The case, brought in June by 25 states and the District of Columbia, concerns rules implementing the 2025 federal tax and policy law. From January 1, 2027, affected Medicaid expansion beneficiaries must generally complete 80 hours of work or community service monthly, or study at least half-time. The decision leaves those underlying requirements intact.
Congress excluded several groups on medical grounds, including people with substance use disorders, disabling mental disorders or serious or complex conditions. CMS added a test requiring their conditions to significantly impair their ability to meet the work requirements. Stearns found that the agency could not narrow the categories Congress had expressly protected.
The separate court order vacates that added language and prohibits its enforcement against the plaintiff states. It also bars federal officials from penalizing those states for errors or delays in implementing the rule for six months from the order's date. That relief concerns implementation penalties; it does not repeal the statutory work requirements.
The states did not win every challenge. The opinion leaves in place a 12-month lookback limit for claims and encounter data used to verify medical frailty, alongside a limit of one self-attestation per continuous enrollment period. The court accepted the government's explanations for those provisions. AP reported that HHS and CMS did not immediately respond to its request for comment.
New York Attorney General Letitia James welcomed the decision as protection for access to care for people with serious illnesses and disabilities. The Massachusetts attorney general's office said the extra conditions risked interrupting coverage. States now face implementation work under the remaining rules, with the judgment removing the disputed medical test while preserving other verification requirements.
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