CMS proposes changes to Marketplace pre-enrollment verification process

The Centers for Medicare & Medicaid Services Oct. 23 released a proposed rule implementing new Health Insurance Marketplace eligibility verification requirements enacted under public law 1, which was signed into law in July 2025. Beginning in plan year 2028, this proposal would require the Marketplaces to verify certain eligibility information before providing advance premium tax credits and cost-sharing reductions, particularly related to citizenship and lawful presence status; residency; non-employer-sponsored minimum essential coverage; and annual household income, family size and eligible noncitizen status. The rule also would require enrollees to provide or confirm key eligibility information annually to continue receiving financial assistance, essentially ending automatic reenrollment for enrollees receiving premium tax credits. Comments are due 30 days after publication in the Federal Register.