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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 a permanent injunction blocking the federal government's new definition of medical frailty. The court found that the government's standards were excessively restrictive and that an unlawful definition could wrongfully disenroll eligible, vulnerable individuals. Furthermore, the decision highlighted that states lacked the necessary time and administrative resources to adequately overhaul their eligibility systems.

Key points

  • Vulnerable beneficiaries will be protected from disenrollment that could interrupt critic…: Vulnerable beneficiaries will be protected from disenrollment that could interrupt critical continuity of medical care.
  • The scheduled rollout of Medicaid work requirements may now face significant delays past…: The scheduled rollout of Medicaid work requirements may now face significant delays past the start of the year.
  • Federal courts determined that enforcing excessively restrictive medical frailty rules ca…: Federal courts determined that enforcing excessively restrictive medical frailty rules causes irreparable harm to states and the public.

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 rules regarding who is considered too sick to work were too restrictive, and said that the suit from over 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. The court accordingly will issue the permanent injunction requested by the States,” Stearns wrote in his order.

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