Seriously ill Americans will have an easier path to keeping their Medicaid coverage after a federal judge struck down an extra hurdle for patients seeking an exemption from new work requirements. The October 29 ruling blocks a Trump administration rule that could have required people with serious illnesses to prove their conditions kept them from meeting the requirements.
Congress established the work requirements in the 2025 tax and spending law known as the One Big Beautiful Bill Act. But lawmakers included exemptions for people with serious medical needs, certain disabilities, disabling mental disorders and substance use disorders. The Centers for Medicare & Medicaid Services (CMS) added another test: qualifying patients also had to show that their conditions significantly limited their ability to meet the work requirements.
That extra test could have put patients through more paperwork while they were already dealing with an illness. North Carolina Attorney General Jeff Jackson’s office offered one example: a patient undergoing chemotherapy could have been required to prove both that they were seriously ill and that their illness prevented them from meeting an 80-hour monthly requirement. State officials warned that additional records, doctor’s notes and evaluations could put eligible patients at risk of losing coverage during treatment.
U.S. District Judge Richard Stearns in Boston ruled that CMS had narrowed the medical exemption beyond what Congress allowed. He ordered the disputed language removed and permanently blocked its enforcement, giving a partial victory to 25 states and the District of Columbia. North Carolina officials estimated that the restriction threatened coverage for 64,000 residents with cancer and other serious illnesses.
The ruling leaves the broader work requirements in place. Beginning January 1, 2027, affected Medicaid expansion enrollees ages 19–64 generally must work or perform community service for at least 80 hours a month, or attend school at least half time, unless they qualify for an exemption. The judge also upheld other paperwork rules, including a restriction on accepting medical evidence more than a year old.
For patients managing serious illnesses, keeping coverage can mean continuing treatment, filling prescriptions and seeing their doctors without an interruption. The decision removes an additional test that could have stood between those patients and their care, while preserving the medical exemptions Congress included in the law.
