New federal guidance asked chronically ill people on Medicaid for a second kind of proof. On Thursday, Oct. 29, a federal judge in Boston set it aside. U.S. District Judge Richard Stearns ruled that the guidance's extra work-rule test can't be applied to these enrollees. The Associated Press report ran in Friday's Journal on page A5. It's short, and we'll keep this short too.
Start with the law. The 2025 law known as the One Big Beautiful Bill added work requirements to Medicaid. It also carved out an exemption for the "medically frail." The law names four groups that must count. People who are blind or disabled. People with substance-use disorders or disabling mental disorders. People with certain disabilities that seriously limit daily life. And people with serious or complex medical conditions. That's four doors into the exemption.
Then came guidance from the Centers for Medicare and Medicaid Services, or CMS. It asked for more than the law did. Fitting one of the four groups wasn't enough. People also had to show their condition made it hard to keep up with the work rules. The guidance's phrase was "significantly impair." In plain terms, a second test on top of the first. A coalition of 25 states and the District of Columbia sued in June over that guidance. Stearns gave them a partial victory, which means they didn't get everything they asked for. HHS and CMS didn't immediately comment. The ruling can be appealed, and we report it without taking a side on the law.
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Health Costs, and Retirement M10. The work rules in the 2025 law are aimed at working-age adults, roughly 19 to 64, who got coverage through the Medicaid expansion. A parent over 65 in a nursing home isn't the target. The rules can touch a grown child with a mental illness or a sibling with a serious condition. In states that expanded Medicaid, they can also touch an early retiree with a small reported income who uses it as a bridge to Medicare at 65. For the chronically ill in that group, this ruling takes away one hurdle. It doesn't take away the paperwork. Someone still has to show the person fits one of the four groups. That's a medical record, kept current, in a folder you can put your hand on. Rulings like this often get appealed, and guidance gets rewritten. The folder holds up either way.
Here's the check this week. If someone in your family is between 19 and 64, on Medicaid and living with a serious condition, pull the file. Find the latest diagnosis letter, the treating doctor's name and number, and the coverage renewal date. If any letter is more than a year old, ask the doctor's office for a fresh one now, before the renewal notice arrives. If you plan to retire before 65 on a small income, put Medicaid's work rules and exemptions on your list for those years. Bring the dates to your next review and we'll put them on the calendar with yours.