A federal judge in Boston on Thursday struck down a key part of the Trump administration's guidance on who qualifies as medically frail under new Medicaid work requirements.

U.S. District Judge Richard Stearns ruled that the Centers for Medicare and Medicaid Services overstepped by requiring individuals with certain conditions to prove their illnesses significantly impair their ability to work, attend school, or engage in community service. The decision came in a lawsuit brought by 25 Democratic-led states and the District of Columbia.

The ruling effects implementation of the One Big Beautiful Bill Act, signed by President Trump in 2025. That law mandates most adults aged 19 to 64 on Medicaid expansion to complete 80 hours per month of work, community engagement, or half-time education starting January 1, 2027. It exempts those deemed medically frail.

Stearns, appointed by President Bill Clinton, found the CMS definition issued in June unlawful because it went beyond the categories Congress specified in the statute. He issued a permanent injunction blocking enforcement of the narrower standard nationwide.

The work requirements themselves remain intact. The court also granted states a six-month delay after the January start date before they can terminate coverage for those seeking the medical exemption, giving time to update eligibility systems.

CMS declined to comment on the decision or any potential appeal. The ruling provides relief to states facing costs to overhaul verification processes and reduces the risk that eligible beneficiaries with serious conditions could lose coverage.

Medical groups praised the outcome for protecting access to care. The decision leaves in place other aspects of the frailty verification process, including limits on accepting older diagnoses.