WEEKLY UPDATE: 11/05/26
A federal judge has rejected the federal government’s new definition of the “medical frailty” exemption for Medicaid work requirements and ruled that states did not have adequate time or resources to overhaul their eligibility systems — siding with a coalition of states, including Connecticut, that filed a lawsuit against the Trump administration in June.
In a statement, Connecticut Attorney General William Tong said, “This was another web of useless red tape concocted by Trump to deny millions of Americans access to healthcare. We sued and we stopped him, and we’re going to keep fighting to protect access to Medicaid free from arbitrary and cruel bureaucratic barriers.”
The Connecticut Department of Social Services (DSS) is assessing the ruling and considering how to adjust the state’s approach. If the ruling survives expected appeals, DSS anticipates the order will simplify the process for identifying individuals who meet the medical frailty criteria. However, while the District Court decision eliminates an extra barrier to eligibility, Medicaid work requirements will still take effect January 1, 2027, and create coverage risks for thousands of Connecticut HUSKY D members.
Permanent Injunction Prevents Implementation of Burdensome Two-Prong Test
The order, issued by Judge Richard D. Stearns of the U.S. District Court of Massachusetts on October 29, vacated regulatory language that would have complicated determination of whether a Medicaid enrollee who is blind or otherwise disabled — with a substance use or mental health disorder, or a physical, intellectual, or developmental disability — is exempt from the work requirement.
The Centers for Medicare & Medicaid Services’ (CMS) interim final rule, published in June, stated the medical frailty exemption applies only if one of the designated conditions “significantly impairs” an enrollee’s ability to comply with the requirement. Stearns’ order included a permanent injunction preventing CMS from enforcing that portion of the rule, which would have required enrollees to prove that the severity of their disability or illness would bar them from working.
“Because enforcement of an unlawful definition of ‘medically frail’ may lead to the disenrollment of otherwise eligible vulnerable individuals relying on Medicaid coverage for continuity of care, the States (and public) face potential for great hardship in the absence of an injunction,” Stearns wrote in his decision. He said CMS “lacked authority to exclude any subset of individuals in the five subcategories delineated as ‘medically frail’ by Congress.”
Additionally, Stearns granted the 25 plaintiff states and Washington, D.C., a six-month stay of enforcement to revise their eligibility verification systems. The stay does not extend to states that weren’t parties to the litigation, but the vacatur of CMS’s medical frailty definition applies nationwide.
The lawsuit also challenged CMS’s requirement that states use only the previous 12 months of health claims and encounter data to assess someone’s medical frailty. The plaintiffs also took issue with restrictions on the use of self-attestation forms. Stearns disagreed with those challenges and upheld the related provisions.
