Missourians with certain medical conditions could have an easier time proving they are exempt from new Medicaid work requirements that go into effect next year, after a federal ruling last month.
Starting Jan 1., Medicaid expansion enrollees age 19 to 64 will need to show at least 80 hours of work, community service, job training or education per month. Under the "One, Big Beautiful Bill" Act, people considered "medically frail" are supposed to be exempt.
But a planned U.S. Centers for Medicare and Medicaid Services rule would require those people to prove not only their underlying conditions, but also the fact that their condition "significantly impaired" their ability to work.
U.S. District Judge Richard Stearns, in Boston, decided that was too strict an application of the law.
"Enforcement of an unlawful definition of 'medically frail' may lead to the disenrollment of otherwise eligible vulnerable individuals relying on Medicaid coverage for continuity of care," Stearns said in his decision.
While no Missouri residents are a party to the dispute presided over by Stearns, Legal Aid of Western Missouri is involved in another, separate lawsuit over the same issue.
Amber Christ, the Kansas City nonprofit's executive director, says the change could save their client, 25-year-old Missouri resident Emily Byrd, a lot of heartburn.
Byrd has several diagnosed conditions, including autism, obsessive-compulsive disorder, post-traumatic stress disorder, social anxiety and social phobia. Twice, Byrd has lost coverage, and both times were due to administrative issues.
While Byrd qualifies under the Medicaid Act as medically frail, the burden of proof raised some concerns.
"Had it (the CMS rule) stayed in place, thousands more people would have lost their eligibility even though they meet the exemption, because of that burden of proof," Christ said, estimating close to 140,000 Missourians were at risk.
While the judge blocked the additional burden of proof, Stearns upheld several federal restrictions, including a requirement that states reject proof of a patient's medical frailty if the diagnosis is more than a year old.
The Trump administration has previously indicated it is eager to appeal Stearn's decision and pause its enforcement until legal matters play out. It is unclear when an appeal will be filed.
Because Missouri was not part of the lawsuit, the state will have a tight deadline — of Jan. 1, 2027 — to account for the changes. Stearn gave states that were party to the lawsuit a longer, six-month window to overhaul their software and enrollment systems to reflect the decision.
"We're going to have to keep pushing to make sure people who are sick don't fall through the cracks in January, when those work requirements become effective," Christ said.
Christ said Legal Aid's lawsuit on behalf of Byrd, alongside several other plaintiffs and medical groups from around the nation, is still pending.
Following Stearn's decision last month, several of these medical groups, including the American Medical Association, spoke up in support.
"Patients should not have to clear unnecessary bureaucratic hurdles to keep their health coverage, especially hurdles that go beyond what Congress intended," said AMA President Willie Underwood.
Anybody concerned or confused about new paperwork can call a Legal Aid of Western Missouri hotline at 1-866-897-0974.
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