People seeking financial help to buy Affordable Care Act coverage would have to clear eligibility checks before receiving subsidies under a federal proposal that would begin with 2028 health plans.
The Centers for Medicare & Medicaid Services proposed the changes on October 23. They are not a new requirement for the upcoming 2027 coverage year, and the rule is still open for public comment.
Under the CMS proposal, exchanges would verify household income and family size, citizenship or eligible noncitizen status, place of residence, and eligibility for or enrollment in other qualifying coverage before providing advance premium tax credits or income-based cost-sharing reductions.
Currently, applicants who otherwise appear eligible can receive financial help during a period when the exchange is seeking documents to resolve information it could not verify electronically. The proposal would stop financial assistance during that period. Consumers could still enroll without subsidies while verification is pending.
Returning customers would also have to confirm eligibility information annually and have it verified to keep financial assistance through automatic re-enrollment. Someone who did not return and complete that process could be re-enrolled in coverage without the subsidies.
CMS proposes an earlier verification window beginning August 1 each year. The first would open August 1, 2027, for 2028 coverage, giving new and returning applicants time to submit information before open enrollment.
The proposal includes a contingent plan-selection option: consumers could choose a plan that would start only after they qualify for financial assistance. For people who instead enroll while checks are pending, CMS proposes retroactive assistance for months they were enrolled during that period once eligibility is verified.
CMS says the changes would implement provisions of the 2025 federal tax-and-spending law and reduce improper enrollments. The proposed rule also includes exceptions for certain family-size changes that trigger special enrollment periods. Public comments are invited for 30 days after publication in the Federal Register.
JBizNews Desk | Washington, D.C.
© JBizNews.com. All rights reserved. Unauthorized reproduction or redistribution is strictly prohibited.
