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STAT+: Federal judge rejects new Medicaid ‘frailty’ definition for work requirements

By · Via STAT Health · Published by Everything Blog

In short

Judge Richard D. Stearns of the U.S. District Court of Massachusetts issued the decision on Thursday following a legal challenge mounted by more than two dozen states. The court found that states did not have the necessary time or resources to modify their eligibility systems under the federal standard. Judge Stearns warned that enforcing this unlawful definition risked improperly dropping eligible, vulnerable individuals from the healthcare program. The resulting injunction halts the immediate enforcement that would have otherwise triggered significant hardship for states and beneficiaries alike.

Key points

  • The planned start-of-year rollout for Medicaid work requirements could face significant o…: The planned start-of-year rollout for Medicaid work requirements could face significant operational delays.
  • Enforcing the rejected standard would have posed a major risk of vulnerable recipients lo…: Enforcing the rejected standard would have posed a major risk of vulnerable recipients losing health coverage.
  • The court issued the injunction because states proved that proceeding under the rules wou…: The court issued the injunction because states proved that proceeding under the rules would cause irreparable harm.

Sources checked by our analysis pipeline: 1

The rollout of Medicaid work requirements may be delayed past the start of the year after a federal judge on Thursday rejected the federal government’s new definition of “medical frailty” and ruled that states did not have adequate time or resources to overhaul eligibility systems.

Judge Richard D. Stearns of the U.S. District Court of Massachusetts ruled that federal regulations on who is too sick to work were too restrictive, and said that the suit from more than two dozen states successfully demonstrated that implementation of the Medicaid work requirements, as written, would cause “irreparable harm.”

“Because enforcement of an unlawful definition of ‘medically frail’ may lead to the disenrollment of otherwise eligible vulnerable individuals relying on Medicaid coverage for continuity of care, the States (and public) face potential for great hardship in the absence of an injunction,” Stearns wrote in his order.

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