What The October 29 Ruling Changed

A federal court struck down the extra impairment test that CMS had added to the definition, and kept the limits on data and self-declaration.

CMS's June 2026 rule added an extra test on top of the five groups: the member's condition also had to significantly impair their ability to meet the 80-hour monthly requirement. On October 29, 2026, Judge Richard Stearns of the federal court in Massachusetts struck down that added test. He ruled that CMS had exceeded its authority.

Figure 1. How The Rules Got Here

June 3, 2026: CMS publishes the interim final rule. September 2026: CMS issues frailty guidance. October 29, 2026: a federal court strikes down the added impairment test. January 1, 2027: work requirements begin in most states. January 1, 2028: self-declaration narrows to once per enrollment period.
What Still Stands
The court upheld two limits: states may verify frailty using only the past 12 months of claims and encounter data, and from 2028 members can self-declare only once per enrollment period.
Extra Time For Some States
The 25 states and D.C. that brought the case received a six-month pause on federal enforcement of frailty decisions, giving them time to update their systems.
Still Unsettled
Reports differ on whether the ruling covers every state or only the 25 states and D.C. that brought the case. CMS hasn't said whether it will appeal. A second case, Taylor v. Kennedy, is pending in Maryland and also challenges the limit on self-declaration.
Tip:
Build the impairment check as a setting your team can switch off, rather than logic written into every rule.