Medicaid
Judge blocks stricter 'medically frail' test in Medicaid work rules
A Boston federal court sided with 25 states, including New York, against a federal rule that would have made seriously ill adults prove their condition keeps them from meeting new Medicaid work requirements.
Key facts
- A judge struck down a key part of the federal 'medically frail' definition.
- Work requirements for adults 19 to 64 still begin January 1.
- An appeal is possible.
What happened
On October 29, U.S. District Judge Richard Stearns in Massachusetts ruled that a central piece of a federal rule defining who is "medically frail" under the new Medicaid work requirements is unlawful. Starting January 1, many Medicaid adults ages 19 to 64 must log 80 hours a month of work, volunteering, job training or school to keep coverage. People who are medically frail are exempt.
The federal rule would have required people to show that their condition "significantly impairs" their ability to meet those hours. A coalition of 24 states plus Washington, D.C., sued in June; New York Attorney General Letitia James was part of it. The judge granted the states' motion on that central provision but left other parts of the rule standing, according to NBC News.
What it means for families
The work requirements still start January 1. What changed is that states cannot use the stricter federal test to decide who qualifies for the medically frail exemption, at least for now.
Federal officials could appeal, so the rules may shift again before or after January.
People 65 and older are not subject to the work requirements, but many family caregivers and adult children with chronic illnesses are.
New York's Attorney General said the ruling keeps many New Yorkers with cancer, disabilities, serious mental illness or addiction eligible. New York has not yet announced how it will screen for frailty.
What to do this week
- Open and answer every Medicaid letter quickly, especially renewal notices.
- Keep a current list of diagnoses and doctors' notes for anyone who may need the exemption.
- Ask your county Medicaid office how frailty will be documented.
Sources
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