Federal Judge Blocks Narrower Medicaid 'Frailty' Definition, Siding with Critics of Work Requirements

A federal judge has ruled that the Trump administration exceeded its authority by redefining the Medicaid 'frailty' exception, a change that would have forced more beneficiaries with health problems to meet work requirements. The decision, issued by U.S. District Judge James Boasberg in Washington, D.C., invalidates guidance from the Centers for Medicare & Medicaid Services (CMS) that narrowed the definition of 'medically frail' — a category exempt from work rules. The ruling is a significant setback for the administration's push to add work requirements to Medicaid, a policy already adopted in several states. Judge Boasberg found that CMS's new definition conflicted with the Medicaid statute and congressional intent, stating that the agency 'cannot rewrite the law.' The lawsuit was brought by the National Health Law Program and other advocates on behalf of Medicaid beneficiaries in Kentucky and Arkansas, two states with approved work requirements. They argued that the stricter definition would cause thousands of people with serious health conditions to lose coverage. The ruling could influence pending litigation over work requirements in other states and may prompt CMS to reconsider its approach. The decision underscores the legal hurdles facing efforts to reshape Medicaid through administrative action, putting the future of work requirements in doubt.