US judge blocks Trump's restrictions on work requirement to maintain health insurance

On Thursday, a US federal judge exempted people with chronic diseases and beneficiaries of the Medicaid program from new rules for work requirements imposed by the administration of President Donald Trump to qualify for exceptions designated for those suffering from “severe health fragility.” The ruling by U.S. District Judge Richard Stearns was a partial victory for a coalition of 25 states and the District of Columbia that sued the administration in June, challenging the Centers for Medicare & Medicaid Services' (CMS) guidance on the "Big Beautiful Bill."

The law was passed in 2025, imposing for the first time a federal work requirement to obtain Medicaid coverage. Its definition includes people with severe health vulnerabilities, such as the blind, people with disabilities, those with substance use disorders or disabling psychological disorders, and those who have disabilities that severely affect their daily activities, or serious and complex medical conditions.

However, the centers tightened the conditions for exemption, requiring that these individuals prove that their health conditions “significantly impair” their ability to comply with work requirements. This interpretation, issued in June, raised objections from states and patient advocates, because previous guidance did not indicate adopting stricter requirements.

The states were racing against time to launch systems implementing work requirements by January 1, which forced them to make additional amendments to take into account the new interpretation. The judge's ruling now requires her to change her plans again.

Patient advocates warned that the new rule would impose significant administrative burdens, as patients may be required to provide documentation proving that their conditions prevent them from working, as well as that the severity of the illness and its impact on the ability to work may change over time. This requirement would also put doctors in a difficult position, as they might be required to determine their patients' ability to work, a decision that could directly affect the continuation of their health coverage.

The plaintiffs believed that stricter conditions for the exemption would deprive qualified Americans of health care, and would go beyond the letter of the law. The judge agreed that there was a risk of irreparable harm.

“Applying an unlawful definition of health fragility could deny eligible people the Medicaid coverage they rely on to continue receiving care, exposing states and the public to significant hardship unless a court order prevents it,” Stearns said in his ruling. The ruling is expected to help some people get or keep health coverage, said Morgan Henderson, a Medicaid economist at the Hilltop Institute at the University of Maryland in Baltimore County.

North Carolina Secretary of Health and Human Services, Dr. Dave Sanghvai, said that the decision will also spare patients from situations that raise stress and anxiety, adding: “This decision allows us to focus on what is most important, which is providing reliable health care to the most vulnerable in our state when they need it most.” But the judge did not give the states a complete victory, as he upheld two other federal restrictions on how they can verify health vulnerabilities.

The first restriction obliges states to reject medical documents proving fragile health if more than one year has passed since the diagnosis, while the second allows accepting only one self-declaration from the beneficiary regarding his or her health condition during each continuous registration period. Justice Stearns justified upholding these restrictions by saying, “The government provided a reasonable justification for each and explained why it was not persuaded by the states’ concerns that beneficiaries might be denied health coverage.”

The Centers for Medicare and Medicaid Services declined to comment on the ruling. These restrictions fall within the comprehensive tax and policy law approved by President Donald Trump in 2025, and affect beneficiaries of the expansion of the Medicaid program, which allowed more low-income people to obtain government health care.

Starting next January 1, beneficiaries of the expansion programs, between the ages of 19 and 64, will have to prove that they work or perform community services for at least 80 hours per month, or attend an educational institution one or more part-time. Exceptions include those with severe health fragility and participants in addiction treatment programs, among other categories.

States, including Nebraska and Montana, have already begun implementing these requirements. According to Congressional Budget Office estimates issued last summer, work requirements could increase the number of people without health insurance by about 5.3 million by 2034.