Federal Judge Richard Stearns Blocks Donald Trump's Medicaid Rule Forcing Chronically Ill Patients to Prove They Cannot Work
A federal judge in Boston has blocked a rule from President Donald Trump's administration that would have forced chronically ill people on Medicaid to prove their conditions prevent them from meeting new work requirements in order to qualify for medical exemptions, handing a partial victory to a coalition of 25 states and the District of Columbia.
US District Judge Richard Stearns issued the 16-page ruling on Thursday, October 29, 2026, siding with the states, which sued the administration in June over guidance from the Centers for Medicare and Medicaid Services (CMS) tied to the 2025 law known as the One Big Beautiful Bill.
What the law says — and what the rule added
Under the law, the definition of "medically frail" must include people who are blind or disabled, people with substance use disorders or disabling mental disorders, people with certain disabilities that significantly impair daily activities, and people with serious or complex medical conditions.
The administration's rule went further. It required people in those categories to show that their conditions also "significantly impair" their ability to comply with the law's work requirements — an extra test the states argued unlawfully narrowed who could get an exemption and would keep eligible Americans from the care they need.
Judge Stearns agreed that the additional test went beyond what the law allows. "The states have met their burden of showing irreparable harm for which monetary damages would provide inadequate compensation — they face the burden of costly and intensive alterations to their eligibility verification systems," he wrote. CMS declined to comment on the decision.
What the ruling does not do
The decision is a partial victory, not a wholesale rejection of the administration's approach. Judge Stearns did not strike down the Medicaid work requirements themselves, and he upheld two other federal restrictions on how states can verify medical frailty that the states had also challenged: the requirement that states reject proof of a patient's medical frailty if the diagnosis is more than a year old, and a policy allowing states to accept only one self-attestation per continuous period of enrollment.
The underlying work requirements remain on track. Starting January 1, 2027, Medicaid expansion enrollees aged 19 to 64 must show that they work or do community service at least 80 hours a month, or are in school at least half the time, unless an exception applies. Exceptions include medical frailty and addiction treatment — which is why the definition of that category matters so much to states and patients.
Medicaid is the public health insurance program for low-income people, funded jointly by state and federal governments. Judge Stearns serves on the US District Court for the District of Massachusetts and was appointed to the federal bench by former President Bill Clinton.
The ruling makes it easier for some Medicaid recipients with qualifying medical conditions to obtain an exemption from the new work requirements — without having to prove, on top of their diagnosis, that their illness also keeps them from working.
Sources: Al Jazeera, October 30, 2026; Associated Press via La Nación, October 29, 2026; Daijiworld, October 30, 2026.