Federal judge rules the administration broke the law by narrowing who counts as “medically frail”

A federal judge today sided with Attorney General Dan Rayfield, ruling that the Trump Administration broke the law when it tried to make it harder for people with serious illnesses and disabilities to keep their Medicaid coverage.

“The Trump Administration tried to strip Medicaid access from people who are seriously ill and can least afford to lose their coverage, in violation of rules written by Congress,” said Attorney General Rayfield. “This ruling means Oregonians fighting cancer or living with a disability can keep their focus on their health, not whether they’re going to lose the coverage that’s keeping them alive.”

Last year’s federal budget bill (HR 1) created steep barriers that will make it harder for many eligible adults to keep Medicaid coverage, including harsher new paperwork requirements to prove they’re working, in school, or volunteering. Congress made an exception for people who are “medically frail” — people living with serious illnesses or disabilities. But this summer, the federal Centers for Medicare & Medicaid Services (CMS) rewrote what that term means, narrowing who qualifies and piling on even more new paperwork.

Oregon and a coalition of states sued in June. Today, the U.S. District Court for the District of Massachusetts agreed with the states. The court threw out the administration’s definition of “medically frail,” permanently blocked it, and gave states six months before enforcement begins so they have time to make the changes without vulnerable patients falling through the cracks.

background

Medicaid — which in Oregon is called the Oregon Health Plan(Opens in a new tab/window) — is the health care safety net for low-income people. States and the federal government pay for it together, with the federal government covering at least half the cost.

More than 1.4 million Oregonians receive health care through the Oregon Health Plan, covering 33% of adult Oregonians and 55% of children (0-17).

States had been working with CMS for months on how to roll out the new work requirements that were written into Trump’s 2025 budget bill. Then, with little warning, CMS issued a rule that made it harder for people with serious health conditions to qualify for an exemption and added layers of red tape that put eligible people at risk of losing coverage — including people who are already working or should be exempt. The states argued CMS ignored evidence it should have considered, didn’t weigh reasonable alternatives, and left states without clear, workable guidance.