Arthritis Foundation Joins Patient Groups Urging Court to Protect Medicaid Medical Frailty Exemptions

ATLANTA — Nov. 5, 2026 — The Arthritis Foundation has joined 31 other public health, patient advocacy and civil rights organizations in an amicus brief supporting a legal challenge to federal Medicaid work requirements and their impact on people with serious or complex medical conditions.

The brief was submitted in Taylor v. Kennedy, a federal lawsuit brought by Medicaid beneficiaries, healthcare organizations and the City of Columbus, Ohio. The lawsuit challenges provisions of a June 2026 rule issued by the Centers for Medicare & Medicaid Services (CMS) to implement new Medicaid work and community engagement requirements under the 2025 federal budget reconciliation law.

Congress established an exclusion from these requirements for people who are medically frail or have special medical needs, including those with serious or complex medical conditions. The coalition argues that CMS improperly narrowed this protection by requiring individuals to additionally demonstrate that their condition significantly impairs their ability to meet work requirements, while imposing additional documentation and verification barriers. These restrictions could prevent eligible individuals from accessing the exclusion and put their coverage at risk.

Why This Matters for People With Arthritis

Arthritis is a leading cause of disability, and many forms are chronic, progressive and unpredictable. Pain, fatigue, stiffness, inflammation and mobility limitations can fluctuate substantially, affecting a person's ability to work and manage daily activities.

Many people with arthritis can and do work while managing serious medical conditions. Their ability to work does not necessarily reflect the complexity of their medical needs or the importance of continuous treatment. Requiring people with qualifying serious or complex medical conditions to additionally demonstrate that their illness significantly limits their ability to meet work requirements could create unnecessary barriers to Medicaid coverage.

For people with inflammatory arthritis who rely on Medicaid, coverage interruptions can mean missed rheumatology appointments, difficulty accessing prescription medications, including disease-modifying therapies, interrupted infusions or physical therapy, and delayed treatment. These disruptions can compromise disease management and, in some cases, contribute to irreversible joint damage. Administrative requirements can create additional challenges for patients already managing multiple appointments, unpredictable flares and ongoing medical care.

Having arthritis does not automatically qualify someone for a medical frailty exclusion. Eligibility depends on the applicable criteria and individual circumstances. The Arthritis Foundation's concern is that people who qualify under the law should be able to access these protections without unnecessary administrative barriers or preventable coverage losses.

Protecting Access to Care

In September, the Arthritis Foundation joined a separate amicus brief in Massachusetts v. Oz, challenging CMS' interpretation of medical frailty protections. On October 29, a federal judge ruled that CMS could not enforce its additional requirement that people with qualifying medical conditions demonstrate that their conditions significantly impair their ability to meet Medicaid work requirements. The court blocked that restriction but upheld other challenged documentation and verification provisions.

Although Massachusetts v. Oz and Taylor v. Kennedy are separate legal proceedings brought by different plaintiffs, both address concerns about protecting Medicaid coverage for people with serious and chronic health conditions, like arthritis. The Taylor v. Kennedy brief, coordinated by the American Cancer Society Cancer Action Network, emphasizes the consequences for patients, including the importance of continuous coverage and the health risks associated with coverage losses. The brief and accompanying motion for leave to file have been submitted, and the court has not yet formally accepted the brief.

The Arthritis Foundation believes people living with arthritis should have access to affordable, quality healthcare without unnecessary barriers. Medical frailty protections should reflect the realities of serious and complex medical conditions, including fluctuating symptoms and ongoing treatment needs, so that people who qualify can access the coverage protections established by Congress.

What People With Arthritis Should Know

Beginning in 2027, some adults ages 19 to 64 may need to meet new Medicaid work or community engagement requirements to qualify for or maintain coverage. Not everyone will be subject to these requirements, and some people with serious health conditions may qualify for an exclusion. Having arthritis does not automatically qualify someone, so check with your state Medicaid program about your individual circumstances. Keep your contact information updated and respond promptly to Medicaid notices to help avoid preventable gaps in coverage.

Read 2027 Open Enrollment: What People With Arthritis Need to Know for more information about upcoming coverage changes and steps you can take to prepare.

The Arthritis Foundation will continue working with patient organizations and other partners to protect access to affordable, quality care for people with arthritis and other chronic conditions.