Judge strikes down Trump ‘medical frailty’ rule in Medicaid work requirements

A federal judge ruled Thursday that the Trump administration’s definition of “medical frailty” illegally made it harder for certain people to be excused from Medicaid’s work requirement, a victory for Arizona Attorney General Kris Mayes and the attorneys general and governors in 26 other states. 

“This is a major victory that protects the most vulnerable, medically fragile Arizonans who rely on Medicaid to receive critical care,” Mayes said in a written statement. “Arizonans otherwise eligible for coverage shouldn’t lose access to their healthcare because of unnecessary red tape.”

At the center of the challenge was changes made to the program as part of President Donald Trump’s “One Big Beautiful Bill Act,” which created new work requirements for those on Medicaid. The bill was approved with only Republican support in Congress, including from all of Arizona’s GOP congressional members.

In June, the Centers for Medicare and Medicaid Services, or CMS, issued a rule that created work requirements that stated adults ages 19-64 had to complete a minimum of 80 hours of work or community engagement each month or be enrolled in an education program to qualify for Medicaid starting next year. 

But federal Judge Richard G. Stearns said he agreed with the states that CMS overstepped its authority. He also said that Arizona and the other plaintiffs were able to show that the federal government provided “inadequate compensation” for states to implement the changes. 

“It is well-recognized that there is an inherent public interest in ensuring that the government follows the law, and because enforcement of an unlawful definition of ‘medically frail’ may lead to the disenrollment 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, adding that the court will issue a permanent injunction from the language going into effect. 

Stearns also granted a six-month stay of enforcement so states can make the necessary changes to fall more in-line with the changes made by the OBBBA. 

The lawsuit included the Attorney Generals of California, Massachusetts, New Jersey, Colorado, Connecticut, Delaware, D.C., Hawai’i, Illinois, Maine, Maryland, Michigan, Minnesota, Nevada, New Mexico, New York, North Carolina, Oregon, Rhode Island, Vermont, Virginia, Washington and Wisconsin. The Governors of Kentucky and Pennsylvania also joined the lawsuit.