A federal judge has allowed the Trump administration’s stricter Medicaid work requirements to move forward, rejecting a request from Democratic-led states to temporarily block the policy before it takes effect.
The ruling means states will continue preparing for a Jan 1 implementation deadline, when certain Medicaid expansion beneficiaries may need to meet new “community engagement” requirements, including working, volunteering or attending school for at least 80 hours a month, to keep their coverage.
The lawsuit, filed by Democratic state officials, challenges a rule issued under the Trump administration that requires some Medicaid recipients who claim they are “medically frail” to provide proof that they are unable to meet the work requirement.
What did the judge rule on Trump’s Medicaid work requirements?
Judge Richard J Stearns declined to issue a preliminary injunction that would have paused the medical frailty rules while the case continues.
According to Politico, Stearns said the states’ concerns about administrative costs and implementation challenges did not meet the high threshold required for such an intervention. He noted that the federal government is required under the law to cover 90% of states’ implementation costs.
“There is a certain point at which damages fail to justify the issuance of such an extraordinary measure,” Stearns wrote, adding that the states had not shown their potential harm crossed that threshold.
{{/usCountry}}“There is a certain point at which damages fail to justify the issuance of such an extraordinary measure,” Stearns wrote, adding that the states had not shown their potential harm crossed that threshold.
{{/usCountry}}However, the judge rejected the injunction request “without prejudice,” meaning the states can seek another pause later if they can show new evidence of harm.
Stearns also said the legal challenge raises “difficult issues,” including questions about Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz’s “faithfulness to Congressional intent” in creating the stricter medical frailty standards.
Who could lose Medicaid coverage under the new rules?
The requirements apply primarily to adults covered through the Affordable Care Act’s Medicaid expansion.
Under the policy, many non-disabled adults without young children will have to complete 80 hours per month of work, community service, education or other approved activities to remain enrolled.
People who qualify as “medically frail” may receive exemptions, but the dispute centers on how that status will be determined.
The Trump administration’s rule says having a diagnosis alone, even serious illnesses such as cancer, may not automatically qualify someone for an exemption. Beneficiaries may need additional proof showing they are physically unable to meet the requirements.
Democratic officials argue the policy could create significant barriers for people with serious health conditions who struggle to navigate additional paperwork.
Why are doctors and states raising concerns?
Medical groups have warned that the new rules could place additional pressure on doctors who may be asked to provide documentation about patients’ ability to work.
America’s Physician Groups, which represents more than 260,000 doctors and clinicians, argued the policy could force physicians to make decisions outside their traditional role.
The American Medical Association also backed the states’ challenge, saying the rule could increase paperwork burdens and interfere with patient care.
State officials have also raised concerns about how to identify eligible exemptions, with some warning that different states could create different systems for determining who qualifies as medically frail.
The Trump administration has defended the policy, arguing that stricter standards are needed to ensure Medicaid resources are directed toward those who need them most. The administration has estimated the work requirements could reduce Medicaid enrollment and generate major federal savings over the coming decade.