CMS Proposes Verify-First Rule for Health Insurance Subsidies: Four Checks Before Assistance, Starting in 2028
The Centers for Medicare & Medicaid Services (CMS), part of the U.S. Department of Health and Human Services (HHS), issued a proposed rule (CMS-9873-P) on October 23 that would require consumers to pass four eligibility checks before receiving advance payments of the premium tax credit (APTC) or cost-sharing reductions (CSRs) through the health insurance Exchanges, starting with the 2028 plan year. The proposal carries a 30-day public comment period following publication in the Federal Register.
Under current Affordable Care Act policy, applicants submit information such as income and immigration status, which Exchanges try to verify electronically. If the information cannot be verified, the consumer enters an "inconsistency period" to submit documents while financial assistance continues; assistance is reduced or ended only if documentation is not provided by the end of that period.
The proposed rule reverses that order. The four criteria that must be verified before assistance begins are: household income and family size; status as a citizen, U.S. national, or eligible noncitizen (including lawfully present immigrants); eligibility for or enrollment in other qualifying coverage; and place of residence. Consumers could still enroll in coverage without assistance while verification is pending, and once verified, assistance would be provided retroactively for the months they were enrolled.
Current enrollees are also affected: under the proposal, consumers would be automatically re-enrolled with financial assistance only if they return to the Exchange each year to confirm their information and have it re-verified; those who do not would be renewed without assistance, at full price. To give consumers time, CMS proposes a pre-open-enrollment verification period beginning August 1 each year, with the first window opening August 1, 2027, for 2028 coverage. Verification requirements would be waived for certain family-size changes tied to special enrollment periods, such as birth, adoption or marriage, and Exchanges would have to allow "contingent" plan selections that take effect only once eligibility is confirmed.
CMS says the rule implements new premium tax credit eligibility requirements under section 71303 of the Working Families Tax Cuts legislation (P.L. 119-21); the Treasury Department issued related proposed regulations on October 15, 2026. The proposal would apply only to eligibility determinations for plan year 2028 and does not affect the open enrollment for 2027 coverage that begins November 1.
Source: GSM · USA
Source: GSM · USA (original Chinese edition)
Photo: 图：美国卫生与公众服务部总部 Humphrey 大楼（华盛顿），联邦医保与医疗服务中心（CMS）隶属该部。（图：Wikimedia Commons，CC BY 2.0）/ The Humphrey Building in Washington, headquarters of the U.S. Department of Health and Human Services, which oversees CMS. (Photo: Wikimedia Commons, CC BY 2.0)
