AG Rayfield: Judge Blocks Trump Administration’s Attempt to Make Seriously Ill Oregonians Jump Through Additional Hoops to Keep Medicaid

A federal judge in the U.S. District Court for the District of Massachusetts ruled in favor of Oregon and a coalition of states challenging a CMS rule that narrowed the definition of "medically frail" under the Medicaid program. The court permanently blocked the CMS definition and gave states six months before enforcement begins to allow time for implementation without disruption to coverage for vulnerable populations. The litigation arises from HR 1, the federal budget bill enacted in 2025, which imposed new eligibility conditions on Medicaid-covered adults, including work, education, and community engagement documentation requirements. Congress included an exemption for individuals deemed "medically frail," covering people with serious illnesses or disabilities. CMS subsequently issued a rule this summer that narrowed the qualifying criteria for that exemption and imposed additional paperwork requirements on individuals seeking to claim it. Oregon and the coalition states filed suit in June, arguing that CMS acted unlawfully in issuing the narrowed definition. The states alleged CMS failed to consider evidence it was required to weigh, did not evaluate reasonable alternatives, and provided states with guidance that was insufficiently clear and workable for implementation purposes. The court agreed with the states, vacated the administration's definition of "medically frail," and permanently blocked it. More than 1.4 million Oregonians are enrolled in the Oregon Health Plan, representing approximately 33 percent of adult Oregonians and 55 percent of children aged 0 to 17.