Illinois Attorney General Kwame Raoul says a federal court has blocked the Trump administration from enforcing a new definition of "medically frail" that he argues would have made it harder for seriously ill people to keep Medicaid coverage.

Raoul announced Monday that the U.S. District Court for the District of Massachusetts found the administration's implementation of new Medicaid work requirements under the One Big Beautiful Bill Act to be unlawful. The court held that the administration's definition of "medical frailty" is contrary to law, vacated the language, issued a permanent injunction and granted the plaintiff states a six-month stay of enforcement to allow for changes to implementation.

Raoul filed the lawsuit in June 2026, challenging an interim final rule that adopted a new interpretation of key terms like "medically frail," making it harder for medically vulnerable people to prove they qualify for an exemption from the work requirements.

"This decision ensures the most vulnerable Americans will not be forced to jump through bureaucratic red tape to access lifesaving medical care. This was the intent when Congress established the Medicaid program, and I am pleased to see the court agree," Raoul said. "I will continue to advocate for all Illinoisans to have access to affordable healthcare."

What the case is about

Medicaid is a safety net health care program for low-income Americans, jointly funded by states and the federal government, with the federal government providing at least 50% of the cost of services, according to the release. Congress created exemptions from Medicaid's work requirements so that people with serious illnesses and disabilities do not lose coverage or face interruptions in care.

The release says the Centers for Medicare & Medicaid Services surprised states earlier this year with an interim final rule that increased administrative burdens and put eligible people at risk of losing coverage, including those who are already working. Raoul's office says the rule disregarded substantial evidence, failed to adequately evaluate reasonable alternatives and did not give states clear or workable guidance.

According to the release, past state Medicaid work requirement programs have shown that added red tape causes eligible people to lose coverage, placing greater strain on state Medicaid programs, safety net providers and emergency rooms while increasing costs.

Background

The new Medicaid work requirements under the One Big Beautiful Bill Act are set to take effect in 2027 and require certain adult enrollees to show they are engaged in work, school or community service for at least 80 hours a month, with exemptions for people deemed medically frail, according to the Illinois Department of Healthcare and Family Services. CMS issued its interim final rule in June 2026, and a federal judge in Boston ruled Oct. 29 in favor of the coalition of states, according to news reports on the decision; the ruling did not strike down the work requirements themselves.

Who joined the lawsuit

According to the release, joining Raoul in filing the lawsuit were the attorneys general of Arizona, Colorado, California, Connecticut, Delaware, the District of Columbia, Hawaii, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Rhode Island, Vermont, Virginia, Washington and Wisconsin. The governors of Kentucky and Pennsylvania also joined.

All are considered innocent until proven guilty in a court of law.

Source: the original release