Court Blocks Medicaid Rule That Could Affect 150K Marylanders

A federal judge has struck down a Trump administration rule that would have made it harder for people with serious medical conditions and disabilities to qualify for exemptions from new Medicaid work requirements, a decision Maryland officials say could help protect thousands of residents from losing health coverage.

The U.S. District Court for the District of Massachusetts ruled Thursday that the administration's definition of "medically frail" was unlawful, blocking enforcement of that portion of the rule.

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Maryland Attorney General Anthony Brown joined a multistate lawsuit challenging the restrictions in June.

Maryland previously estimated that about 150,000 residents, representing 45 percent of adults covered through the state's Affordable Care Act Medicaid expansion, could lose coverage because of the new federal work requirements.

The ruling does not eliminate Medicaid work requirements. Instead, it strikes down a narrower definition of who qualifies for an exemption because of serious health conditions.

The court also granted the states involved in the lawsuit a six-month pause on enforcing medical frailty eligibility determinations to let them adjust their systems.

"The Trump Administration's unlawful policy would force people who are fighting just to stay alive to meet work requirements or lose their health coverage," Brown said in a statement.

"By securing this victory, our Office is protecting Marylanders who are managing a wide range of serious health conditions, including physical and developmental disabilities."

What The Ruling Means For Maryland Medicaid Recipients

The federal law establishes work requirements for certain adults enrolled in Medicaid through the Affordable Care Act expansion, beginning Jan. 1, 2027.

Generally, affected adults ages 19 to 64 must complete at least 80 hours per month of qualifying activities, such as employment, community service or job training, or meet an education requirement. Certain groups are exempt.

Congress included exemptions for people with serious illnesses, disabilities and other qualifying medical conditions.

However, an interim rule issued by the Centers for Medicare & Medicaid Services in June required medically frail individuals to demonstrate that their conditions significantly impaired their ability to comply with the work requirements.

The coalition of states argued that the additional restriction went beyond what Congress authorized.

The court agreed, struck down the administration's definition and issued a permanent injunction.

The decision means people who fall within the medical frailty categories Congress established cannot be required to meet the additional impairment test to qualify for an exemption.

However, the court upheld other provisions of the federal rule, including limits on how states use older medical claims data and restrictions on self-reported medical conditions.

Thousands Of Marylanders Could Be Affected

Maryland officials previously estimated that approximately 150,000 Medicaid expansion recipients could lose coverage under the broader work requirements.

That estimate reflects the potential impact of the federal requirements overall, not the number of residents whose coverage was directly protected by Thursday's ruling.

The state also estimated that implementing the challenged rule would create approximately $2 million in additional administrative costs.

Brown's office said the decision could reduce those costs while protecting residents with serious medical conditions from unnecessary interruptions in health coverage.

Medicaid provides health insurance to qualifying low-income Americans and is jointly funded by state and federal governments.

The federal work requirements are still scheduled to take effect in January, although the court's order gives states involved in the lawsuit additional time to implement medical frailty exemptions.

Maryland residents can find information about eligibility and coverage through Maryland Health Connection and the Maryland Department of Health.