US judge blocks Trump’s Medicaid rule forcing ill to prove impairment

US District Judge Richard Stearns sided with 25 states and the District of Columbia which sued the administration.

US President Donald Trump talks with Health and Human Services Secretary Robert F Kennedy Jr and Centers for Medicare & Medicaid Services Administrator Mehmet Oz [File: Mark Schiefelbein/AP Photo]

A federal judge has ruled against enforcing a new rule by the administration of US President Donald Trump that would require chronically ill people on Medicaid, a public health insurance programme for low-income individuals, to prove themselves “medically frail” to qualify for work exemptions.

US District Judge Richard Stearns blocked the rule on Thursday, siding with 25 states and the District of Columbia, which had sued the Trump administration in June over the change, arguing that it unlawfully limits exemptions for people with serious medical conditions.

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The law says the definition of medically frail must include people who are blind or disabled, have substance use disorders or disabling mental disorders, have certain disabilities that significantly impair daily activities, or have serious or complex medical conditions.

Workers at a Medicaid call centre in Jefferson City, Missouri, field questions and review information regarding eligibility determinations [File: David A Lieb/AP Photo]

‘Significantly impair’ abilities

But the administration’s rule went further, requiring people in those categories to show that their conditions also “significantly impair” their ability to comply with the law’s work requirements.

The plaintiffs argued that the stricter rule would prevent eligible Americans from accessing the care they need, and that it oversteps the law’s text.

“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,” Stearns said in his 16-page ruling.

The Centers for Medicare & Medicaid Services, the agency that adopted the rule, declined to comment.

Medicaid is a public health insurance programme for low-income people, funded by state and federal governments.

US President Donald Trump, left, speaks to reporters alongside Health Secretary Robert F Kennedy Jr and Centers for Medicare and Medicaid Services Administrator Mehmet Oz in West Palm Beach, Florida, on October 23, 2026 [File: Alex Wong/Getty Images via AFP]

Two restrictions upheld

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. There are exceptions for those considered medically frail or in addiction treatment programmes, among others.

Notably, while the ruling will make it easier for some Medicaid recipients with qualifying medical conditions to obtain an exemption from the new work requirements, Stearns’s decision does not strike down the work requirements as unlawful.

Stearns serves in the District of Massachusetts and was appointed by President Bill Clinton.

His ruling upheld two other federal restrictions on how states can verify medical frailty that the states and the District of Columbia had also contested.

美国地区法官理查德·斯特恩斯支持了起诉政府的25个州和哥伦比亚特区的诉求。

美国总统唐纳德·特朗普与卫生与公众服务部部长小罗伯特·F·肯尼迪和医疗保险和医疗补助服务中心主任穆罕默德·奥兹交谈。[图片：马克·谢费尔贝因/美联社照片]

一位联邦法官裁定，美国总统唐纳德·特朗普政府的一项新规不得执行。该新规要求参加医疗补助计划（一项面向低收入人群的公共医疗保险计划）的慢性病患者证明自己“身体虚弱”，才能获得工作豁免。

美国地区法官理查德·斯特恩斯周四阻止了这项规定，支持了 25 个州和哥伦比亚特区的诉求。这些州和特区在 6 月份就这项变更起诉了特朗普政府，认为该变更非法限制了患有严重疾病的人的豁免权。

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法律规定，体弱多病者的定义必须包括失明或残疾的人、患有药物滥用障碍或致残性精神障碍的人、患有严重影响日常生活的某些残疾的人，或患有严重或复杂疾病的人。

在密苏里州杰斐逊市的医疗补助呼叫中心，工作人员正在接听电话并审核有关资格认定的信息。[图片：David A Lieb/AP Photo]

“显著损害”能力

但政府的规定更进一步，要求这些类别的人证明他们的病情也“严重损害”了他们遵守法律工作要求的能力。

原告辩称，更严格的规定将阻止符合条件的美国人获得他们需要的医疗保健，并且超越了法律条文的规定。

“各州已经履行了举证责任，证明其遭受了无法弥补的损害，金钱赔偿不足以弥补这种损害——它们面临着对其资格验证系统进行代价高昂且深入的修改的负担，”斯特恩斯在其 16 页的裁决中说道。

制定该规定的联邦医疗保险和医疗补助服务中心拒绝置评。

医疗补助计划是由州政府和联邦政府资助的面向低收入人群的公共医疗保险计划。

2026年10月23日，美国总统唐纳德·特朗普（左）在佛罗里达州西棕榈滩与卫生部长小罗伯特·F·肯尼迪和医疗保险和医疗补助服务中心主任穆罕默德·奥兹一起向记者发表讲话。[图片来源：Alex Wong/Getty Images via AFP]

两项限制措施维持有效

自2027年1月1日起，19至64岁的医疗补助计划（Medicaid）扩容计划参保人必须证明其每月工作或从事社区服务至少80小时，或至少一半时间在校学习。身体虚弱或正在接受戒瘾治疗等情况可获豁免。

值得注意的是，虽然该裁决将使一些符合条件的医疗状况的医疗补助受益人更容易获得新工作要求的豁免，但斯特恩斯的决定并没有宣布这些工作要求违法。

斯特恩斯在马萨诸塞州地区任职，由比尔·克林顿总统任命。

他的裁决维持了另外两项联邦限制，这两项限制涉及各州如何核实医疗虚弱状况，各州和哥伦比亚特区也曾对此提出异议。