BOSTON – A federal judge on Oct. 29 blocked a narrower definition of the Medicaid work-requirement exemption for medically frail people, in a case North Carolina brought with other states.
U.S. District Judge Richard Stearns ruled that the Centers for Medicare & Medicaid Services had limited the exemption beyond what Congress authorized. The decision concerns who qualifies for an exemption, rather than eliminating the broader work requirements.
North Carolina Attorney General Jeff Jackson’s office said the additional restriction threatened coverage for an estimated 64,000 state residents with cancer and other serious illnesses. That figure is the state’s estimate, not a count of people who have lost coverage.
The state joined the lawsuit in June after CMS issued its implementation rule. According to the attorney general’s office, the disputed provision could have required a person receiving chemotherapy to establish not only a serious illness, but also that the illness prevented compliance with an 80-hour monthly work requirement.
Congress had exempted medically frail people when it adopted the new requirements. CMS added a test tying an individual’s physical, mental or behavioral health condition to an inability to comply with the community-engagement requirement.
Fierce Healthcare’s Oct. 29 report independently described the ruling as a partial victory for the states. Stearns rejected the narrowed definition but allowed other challenged provisions to stand. The publication reported that the court found the agency’s definition could exclude people within categories Congress had protected.
Jackson’s office said the judge ordered the disputed language removed and granted a permanent injunction against its enforcement. The office also said state health officials and county social services departments had been preparing to administer the new requirements.
The broader Medicaid work requirements remain scheduled to take effect Jan. 1, 2027, according to the state announcement. Thursday’s decision changes the disputed exemption standard; it does not mean that the underlying work requirements have been struck down.
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Photo Credit: File photograph of the John Joseph Moakley United States Courthouse in Boston, September 15, 2024, by 4300streetcar, via Wikimedia Commons; CC BY 4.0. Cropped and resized. Context image, not the October 2026 ruling.
Editor’s Note: This article was drafted with the assistance of artificial intelligence and was reviewed and fact-checked by a member of the NC Political News editorial team before publication.