Chronically ill people on Medicaid won't be bound by new work requirement rules that the latest Trump administration guidance requires in order to qualify for "medically frail" exemptions, a federal judge ruled Thursday.

U.S. District Judge Richard Stearns in Boston gave a partial victory to a coalition of 25 states and the District of Columbia, which sued the Trump administration in June over the new Centers for Medicare and Medicaid Services guidance linked to the 2025 law known as the "One Big Beautiful Bill." The law says the definition of medically frail must include people who are blind or disabled, have substance use disorders or disabling mental disorders, have certain disabilities that significantly impair daily activities, or have serious or complex medical conditions.

But the CMS rule went further, requiring people in those categories to show that their conditions also "significantly impair" their ability to comply with the law's work requirements.