Judge Richard Stearns did something useful on Thursday, and nobody should mistake it for protection.
He struck down the Trump administration's attempt to narrow who counts as medically frail. Under that guidance, a chronically ill person seeking an exemption from Medicaid's work requirement would have had to prove that the illness impairs their ability to work. In other words, being sick wasn't enough. You had to be sick in the way the government approved, and prove it on the government's forms.
The judge was right that CMS overstepped what Congress wrote. But look at what survives: the work requirements themselves, starting Jan. 1, along with the verification provisions and the documentation mandates. The law's central machinery is untouched. CMS tried to add a trapdoor to the exit, and a court nailed it shut. The building is still a maze.
That maze is the point. Supporters of work requirements say they are about dignity and encouraging employment. The evidence is hard to square with that. Most Medicaid expansion adults who can work already do. Those who don't are mostly caregivers, students, people with health problems, or workers in jobs with unstable hours. When Arkansas tried this in 2018, thousands lost coverage within months, and researchers found no meaningful gain in employment. Georgia's version has been criticized for high administrative costs and low enrollment. Policies like these don't reliably move people into work. They reliably move people off the rolls through missed letters, glitchy portals, and a bureaucracy that treats a lost pay stub as a moral failing.
The Congressional Budget Office projected that millions more people would become uninsured as a result of the work provisions. This was not an accident. Those coverage losses are how the savings get counted, and savings from kicking people off Medicaid help pay for tax cuts that flow overwhelmingly to people who will never see a county benefits office.
So the frailty guidance matters because it shows the instinct behind the whole project. Even for people with serious chronic conditions, the administration wanted the burden of proof to fall on the patient. That's a revealing default. The state doesn't have to show you can work. You have to show you can't, repeatedly, to the satisfaction of a system built to find reasons to say no.
Now comes the part Democrats should not hide behind the lawsuit to avoid. Twenty-five states and D.C. deserve credit for suing. But litigation is not a substitute for governing. Blue states now have weeks to build or retool eligibility systems for a requirement many of them opposed. They will be asked to decide how aggressively to find people who qualify for exemptions, how to use data they already hold, how to make self-attestation work, and how to keep paperwork from becoming a purge. Those choices will decide whether a bad law becomes a catastrophe or just a cruelty. Any governor who says "this is Washington's fault" and then runs a sloppy rollout will deserve the anger that follows.
The larger lesson is about what the court can and cannot do. Stearns could say the administration went beyond the statute. He could not say the statute is humane. That fight belongs to voters and to a party that has too often treated Medicaid as a program to defend rather than a promise to expand. If people lose health coverage in the new year because they were sick, caring for someone, or simply missed a notice, the ruling won't help them. Republicans wrote the law, and they should own what follows. Democrats should make sure that every dropped patient has a name, a face, and a Republican vote attached.
How it may affect me
If you are an adult covered through Medicaid expansion, the work requirement is scheduled to start Jan. 1 regardless of this ruling. Watch for notices from your state Medicaid agency, update your address and phone number, and respond quickly. Keep records of work, volunteering, school, caregiving, or medical conditions that could support an exemption. Procedures vary by state, so confirm the specifics with your agency.
