Virginia Attorney General Jay Jones and Gov. Abigail Spanberger
RICHMOND, Va. — Virginia Attorney General Jay Jones is calling a federal court ruling a victory for Medicaid recipients with serious medical conditions after a judge rejected part of the Trump administration’s effort to tighten exemptions from newly enacted Medicaid work requirements.
The U.S. District Court for the District of Massachusetts ruled Oct. 29 that the federal government’s definition of “medically frail” went beyond what Congress authorized under the law known as the One Big Beautiful Bill Act.
The decision followed a lawsuit filed in June by Virginia and a coalition of other states challenging an interim federal rule issued by the Centers for Medicare & Medicaid Services (CMS). The states argued that the rule made it more difficult for people with serious illnesses and disabilities to qualify for exemptions from the new work requirements.
The court vacated the disputed definition and issued a permanent injunction preventing its enforcement against the plaintiff states. It also granted the states a six-month period to address potential administrative problems and delays associated with changing their eligibility systems.
Jones said the ruling will help protect Virginians who depend on Medicaid for treatment of serious health conditions.
“More than 1.8 million Virginians rely on Medicaid to manage complex medical issues, like cancer, stroke care/recovery, and even renal failure, and they deserve clear, stable health insurance,” Jones said. He criticized the administration’s efforts to restrict access to coverage, arguing that the federal rule would have placed additional burdens on vulnerable residents.
Gov. Abigail Spanberger also welcomed the decision, saying patients with cancer and other serious conditions should not face unnecessary administrative obstacles when seeking medical care.
“Cancer patients shouldn’t be forced to jump through bureaucratic hoops to access the lifesaving care they need,” Spanberger said.
What the ruling means
Under the federal legislation, certain Medicaid recipients generally will be required to complete at least 80 hours a month of qualifying activities, including employment, job training, community service or education, to maintain eligibility.
The requirements are scheduled to take effect Jan. 1, 2027, and generally apply to adults ages 19 to 64 enrolled in Medicaid expansion coverage who do not qualify for an exemption.
Congress included exemptions for several groups, including pregnant and postpartum women, certain parents and caregivers, people with disabilities, and individuals considered medically frail or to have special medical needs.
The dispute centered on how the federal government defined medical frailty.
The CMS interim final rule added a requirement that a person’s medical condition significantly impair the individual’s ability to meet the work requirements. The states argued that this additional standard narrowed protections Congress had intended to provide to people with serious medical conditions.
U.S. District Judge Richard Stearns agreed that the administration had exceeded its authority by adding that restriction.
However, the ruling did not eliminate Medicaid work requirements or invalidate the entire federal rule. The judge allowed other provisions to remain in place, including restrictions on using medical diagnoses more than 12 months old to establish medical frailty and limits on self-attestation.
The administration’s position
The Trump administration has defended the new Medicaid requirements as a way to encourage employment, education, job training and community involvement among able-bodied adults receiving government assistance.
CMS has described the policy as an effort to promote economic stability, independence and self-sufficiency while establishing consistent eligibility standards nationwide.
Under the federal rule, affected adults can satisfy the monthly requirement through employment, qualifying volunteer work, participation in approved work programs or education. Individuals who do not meet the requirements may lose coverage, although they can reapply if their circumstances change or they establish eligibility.
The administration’s position reflects a broader argument among supporters of the legislation that Medicaid should encourage workforce participation among adults who are capable of working.
Concerns about coverage and implementation
Opponents, including health care organizations and state officials, have argued that the requirements could cause eligible people to lose coverage because of paperwork, reporting difficulties and administrative errors rather than an unwillingness or inability to work.
The American Hospital Association previously raised concerns about how the federal government would determine medical frailty and whether the exemption process would adequately protect people with complex health conditions.
The association has emphasized that Medicaid coverage helps patients manage illnesses and avoid more expensive, higher-level medical treatment.
Virginia and other states also argued that CMS changed its guidance after states had already invested time and resources preparing to implement the new requirements.
The court’s decision addresses the dispute over medical-frailty exemptions, but the broader implementation of Medicaid work requirements remains a significant issue for state governments, health care providers and beneficiaries.
For Virginia, the decision provides additional protection for medically vulnerable Medicaid recipients as state officials continue preparing for the federal eligibility changes scheduled for 2027.
