Federal judge rules Medicaid medical frailty definition unlawful

Published on October 30, 2026

A federal judge ruled on Thursday that the Trump administration’s definition of “medically frail” used for Medicaid is unlawful, The Hill reported. U.S. District Judge Richard Stearns found that the definition in the One Big Beautiful Bill Act was “contrary to law.” The judge issued a temporary injunction on states having to determine medical frailty and a six-month stay on enforcement, citing the short time states have had to change their verification systems. ¹

The law passed last year included a new definition under which a Medicaid beneficiary had to show a “physical, mental, or other behavioral health condition” that “significantly” impaired the “ability to comply with the community engagement requirement” to be exempt from work requirements. The Centers for Medicare and Medicaid Services issued an interim final rule in June that limited states to using claims and encounter data from the 12 months preceding an application. Stearns agreed with plaintiff states that the 12-month rule was “arbitrary or capricious.”

The American Medical Association welcomed the ruling, and New York Attorney General Letitia James said she had secured relief for some of the state’s most vulnerable residents. The Hill reported that it had reached out to the Department of Health and Human Services for comment.