Judge Blocks Trump Administration's Narrowed 'Medically Frail' Medicaid Exemption as 'Contrary to Law'

U.S. District Judge Richard D. Stearns in Massachusetts ruled Oct. 29 that CMS exceeded its authority narrowing the "medically frail" exemption from Medicaid work requirements under the One Big Beautiful Bill Act, blocking enforcement in a suit by roughly 25 Democratic-led states and Washington, D.C. Stearns found the guidance exceeded what Congress authorized and was "contrary to law," and that states lacked time to overhaul eligibility systems before rollout. He wrote enforcing it could disenroll eligible people who rely on Medicaid for continuity of care.

The ruling leaves the underlying 80-hour-a-month work requirement in place; only the narrowed medical exemption is blocked. It is the latest case of a court finding Trump administration implementation of the 2025 law outpaced Congress's grant of authority, a recurring theme as states sue over OBBBA provisions.

Available reporting does not indicate whether CMS has responded or plans to appeal. The work requirements begin in January 2027, and the ruling does not disturb that timeline.