| A new lawsuit is taking aim at how the Trump administration plans to exempt medically frail people from Medicaid work requirements. The challenge is coming from a coalition of medical groups, low-income patients and the City of Columbus, Ohio, that argues the rule doesn’t reflect how Congress envisioned those requirements. The rule, announced in June, requires certain Medicaid beneficiaries to prove they are working, volunteering, attending school or participating in a qualifying job-training program for 80 hours per month in order to keep their coverage. There are a number of exemptions from the work requirements, but some advocates and health policy experts have raised alarms about the strict definition of what it means to be “medically frail” that the Centers for Medicare and Medicaid Services has outlined in the new rule. In the rule, CMS ultimately tied medical frailty to an individual’s ability to work or otherwise satisfy the requirements, rather than broadly exempting people whose health conditions could deteriorate if they lose coverage. → And the lawsuit alleges that the more narrow definition goes beyond what’s contained in the One Big Beautiful Bill — Republicans’ signature domestic policy law enacted last year — which set up the work requirements. The coalition is asking a federal court to vacate the rule, alleging it’s “arbitrary and capricious and contrary to law.” The suit also alleges violations of the Administrative Procedure Act, the law governing how regulations are issued. “Congress created the medical frailty exclusion to protect people with serious health needs, but the administration’s rule turns that protection into yet another obstacle people must overcome,” said Jane Perkins, litigation director at the National Health Law Program. Going beyond what the statute requires, the lawsuit argues, will lead to people who are medically frail to lose their health insurance “to a far greater degree than anticipated by Congress.” The lawsuit said the policy harms cities — which will have to shoulder the additional costs associated with caring for patients without insurance utilizing public health and emergency services but unable to pay — and providers that will have to evaluate whether patients can meet the work requirements, saying those decisions are “not medical in nature.” CMS said the agency doesn’t comment on pending litigation. But, when the rule was released, Administrator Mehmet Oz said the work requirements were crafted to ensure people don’t take advantage of the system. “The mantra we kept coming back to was that we’re forgiving, but we’re not foolish,” Oz told reporters. “If we make it so easy to defraud [Medicaid] that everyone feels that they’re fooled for not defrauding it, that’s not so good,” he said. The National Health Law Program and legal advocacy group Democracy Forward are leading the legal challenge on the coalition’s behalf. Democracy Forward has successfully persuaded federal courts to pause some of the Trump administration’s efforts to overhaul the Affordable Care Act. Those cases also involve some of the same plaintiffs, including Doctors for America and the City of Columbus. → This lawsuit is just the latest to challenge the CMS rule. In June, about two dozen states sued the Trump administration over the “medically frail” definition. Reports that the White House is considering giving political appointees more control over how the National Institutes of Health distributes research funding have drawn swift pushback from a GOP lawmaker, the pharmaceutical industry and patient advocacy groups. The Post’s Dan Diamond and Riley Beggin reported on Friday that NIH Director Jay Bhattacharya defended the agency’s grantmaking process against criticism from officials including Russell Vought, who leads the White House’s Office of Management and Budget. Vought, who has sought to overhaul the system for federal grants, said during a Friday meeting in the Oval Office that the NIH had funded “woke” initiatives that went against President Donald Trump’s goals. Vought and other administration officials floated an additional review of the agency’s grant-making to Trump and suggested an executive order to establish a commission that could review grants issued by the NIH, according to reporting by The Post. On Friday evening, an NIH spokesperson declined to comment on the meeting but said there would be no “rescissions” — an approach Vought has previously used to pull back federal money — of existing NIH grant funds. “There will be no rescissions to NIH grant monies. All NIH grant monies will be spent,” an NIH spokesperson said in a statement. OMB declined to comment to The Post. Then, Politico went a step further, reporting that Trump directed Vought to write up an executive order that would create a board to decide which NIH grants to fund. Why it matters: The NIH commands a budget of $47 billion, making it the nation’s largest individual funder of biomedical research. Tucked inside a government funding bill, Congress included a provision blocking an OMB proposal that would let political appointees have sway over federal research grants. It’ll be back up for debate when government funding expires in December. Sen. Susan Collins (R-Maine), who leads the Senate Appropriations Committee, said that the continued push to give political appointees more power over grants “is contrary to congressional intent.” “Imposing a political review on awards that have already been selected through a rigorous scientific and merit-based process undermines the long-standing principle that the government funds awards based on scientific need and merit, rather than political ideology,” Collins said in a statement. She has previously asked OMB to withdraw key parts of its proposed rule. - What patient groups are saying: “Giving political appointees the power to cancel NIH medical research grants based on their opinion of a university … should alarm every American — especially the millions of patients counting on treatments and cures that haven’t been discovered yet,” Erika Sward, executive director of United for Cures, a coalition of patient advocacy groups, said in a statement.
- Alzheimer’s group weighs in: “Breakthroughs in Alzheimer’s research take years of sustained work and investment,” Catherine Patterson, the acting chief operating officer of UsAgainstAlzheimer’s, said in a statement. “Allowing anyone to end promising research based on political decisions will delay promising breakthroughs, disrupt ongoing patient clinical trials, and set back meaningful progress.”
- What the industry is saying: “The proposed changes to research-funding decisions could introduce a level of unpredictability that would weaken the scientific ecosystem,” said Alex Schriver, senior vice president of public affairs at the Pharmaceutical Research and Manufacturers of America, or PhRMA. “At a time of intense global competition, creating uncertainty in research funding risks driving talent, discoveries and investment to other countries, ultimately slowing the development of lifesaving treatments for American patients and ceding U.S. leadership.”
“A melanoma vaccine was hailed as a breakthrough. Which cancers are next?,” The Post’s Daniel Wu reports. “Even medical professionals are skipping health insurance because of high prices,” reports Hayat Norimine at KFF Health News. “Smart Ring Maker Oura, Backers Seek $2.2 Billion in US IPO,” Bloomberg’s Subrat Patnaik reports. “Patients Sue GLP-1 Drugmakers Over Risk of Sudden Vision Loss,” the Wall Street Journal’s Alex Janin reports. This newsletter is published by WP Intelligence, The Washington Post’s subscription service for professionals that provides business, policy and thought leaders with actionable insights. WP Intelligence operates independently from The Washington Post newsroom. Learn more about WP Intelligence. | 
