A federal judge in Boston has blocked the implementation of a rule designed to narrow exemptions for Medicaid recipients facing serious medical issues, ruling that federal officials exceeded their legal authority.
U.S. District Judge Richard Stearns issued a decision striking down the methodology established by the Centers for Medicare and Medicaid Services to determine whether an individual qualifies as medically frail. The regulation, which was scheduled to take effect on Jan. 1, had faced a legal challenge from 25 states and the District of Columbia.
Under federal law, most non-disabled adult beneficiaries are required to work, attend school, or participate in volunteer activities for at least 80 hours per month to maintain coverage, unless they qualify for specific exceptions such as medical frailty. The disputed CMS guidance sought to tighten this standard by requiring individuals to demonstrate a medical condition that significantly impairs their ability to meet the mandatory work hours.
Stearns concluded that the agency lacked the statutory power to narrow the definition established by Congress, finding that the narrow interpretation of significant impairment went beyond the powers of the CMS and was therefore contrary to law.
In addition to blocking the rule’s methodology, Stearns granted states a six-month stay on enforcing their determinations regarding medical frailty, noting that the judicial ruling could necessitate adjustments to existing state verification systems. The agency had previously indicated recognition that states would struggle to comply with a compressed implementation timeline.
Medical organizations welcomed the court’s intervention. American Medical Association President Willie Underwood described the ruling as a victory for patients in a statement, asserting that the court properly rejected a federal restriction that would have created unnecessary barriers to care and complicated exemption access for individuals with complex or serious health conditions.
