CMS Implements Pre-Eligibility Verification Changes for Marketplace

The Centers for Medicare & Medicaid Services (CMS) on Oct. 27 published the Exchange Pre-Eligibility Verification proposed rule to implement marketplace eligibility and verification requirements specified in the Working Families Tax Cut legislation (WFTCL). The rule updates eligibility determination procedures for situations when the marketplace cannot verify information provided by the enrollee.

The rule will require the marketplace to verify household income, family size, citizenship, eligibility for other coverage and place of residence before an enrollee can receive advanced premium tax credits. Further, certain eligibility criteria must be verified by the marketplace and confirmed by current enrollees annually, ending automatic reenrollment.

The rule also creates a pre-open enrollment period, beginning Aug. 1, when enrollees can start providing eligibility verification information. Provisions in the proposed rule would be effective for plan year 2028.

Comments are due Nov. 27.

Contact Director of Policy Rob Nelb, MPH, at [email protected] or 202.585.0127 with questions.