RALEIGH, N.C. — About 64,000 seriously ill North Carolinians, many of them cancer patients, will not have to clear an extra federal hurdle to stay exempt from new Medicaid work rules, after a federal judge on Thursday sided with the state and a coalition of others in a fight over the exemption.
The dispute traces to the 2025 federal tax and spending law, which requires many adults who gained coverage through Medicaid expansion, ages 19 to 64, to log at least 80 hours a month of work or community service, or attend school at least half time. Congress carved out people deemed medically frail, a group that includes people who are blind or disabled, people with substance use disorders or disabling mental illness, and patients with serious or complex conditions such as cancer, cystic fibrosis, hemophilia and Parkinson’s disease.
Guidance from the Centers for Medicare and Medicaid Services went a step further. It would have required patients in those groups to also show that their condition significantly impaired their ability to meet the work rule. Under that test, a person in chemotherapy could have been asked for added records, doctor’s notes and evaluations, and risked losing coverage mid-treatment.
Attorney General Jeff Jackson sued in June, arguing the agency had narrowed an exemption Congress wrote on purpose. Richard Stearns, a federal district judge sitting in Boston, agreed that the agency lacked authority for the added test, ordered that language removed from the rule and permanently barred its enforcement.
The ruling was a partial win. Stearns left the work requirements themselves in place and upheld two other federal limits on how states check frailty: states must reject proof based on a diagnosis older than a year, and a patient may self-attest just once during an unbroken stretch of enrollment. He found the government had offered a reasonable rationale for those pieces.
For North Carolina, the decision means the state health department and county social services offices can roll out the work rules without the extra screening, which they had already begun preparing for at added cost. State health Secretary Dev Sangvai called the decision a win for residents fighting serious illness.
The broader work requirements are still set to begin Jan. 1, 2027. North Carolina was one of 25 states plus the District of Columbia in the case, joined by the governors of Kentucky and Pennsylvania.
Filed under: Raleigh NC Health News
