A federal judge ruled Thursday that the Trump administration went too far in its attempt to add new conditions to what it means to be “medically frail” in order to escape new community service requirements for Medicaid.
Judge Richard Stearns, a Clinton appointee to the court in Massachusetts, said anyone who is blind, has a drug abuse problem or is significantly impaired by a physical or intellectual disability is exempt under the law.
He said the attempt by the Center for Medicare & Medicaid Services to add new layers of eligibility goes beyond that.
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But he said the feds were on solid footing in demanding the states use medical evidence from only within the past year when determining medical frailty and on refusing to accept self-attestations.
He said CMS had a good reason for requiring updated information and, even though he signaled he may personally disagree with that, he said it was consistent with the law.
“The government provided a non-frivolous rationale for adopting each provision,” Judge Stearns wrote.
Last year’s One Big Beautiful Bill budget law imposed new requirements on those receiving taxpayer-funded benefits under Medicaid, the federal-state health program for the poor.
Those who gained benefits under Obamacare are supposed to meet a “community engagement” standard, which either means being enrolled in schooling or performing 80 hours of community service each month.
It is slated to take effect on Jan. 1.
The law included exemptions for the blind, the seriously ill and three other categories.
Judge Stearns said Congress intended those categories to be a floor, not a ceiling, and the administration is not free to limit them.
A coalition of Democrat-controlled states led the lawsuit that challenged the CMS interpretation.
“Today’s decision is a major victory that ensures that some of our most vulnerable residents are able to continue to access the healthcare they deserve,” said California Attorney General Rob Bonta.
The stricter rules were issued by CMS in June.
Judge Stearns said given the short timeframe in the law, he was ordering CMS to grant a six-month grace period on medically frail determinations.
Democrats have been critical of CMS’ actions and the initial law itself. Democrats running for Congress have said that if their party retakes control of a chamber in next month’s elections, rolling back the GOP changes will be a top priority.
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