CMS Proposes Verify-First Rule for ACA Subsidies: Four Eligibility Checks Before Payments, Starting With 2028 Plans
The Centers for Medicare & Medicaid Services (CMS) proposed a rule on October 23 that would require Affordable Care Act marketplaces to verify a consumer's eligibility before any advance premium tax credits or cost-sharing reductions are paid. The proposal, called the Exchange Pre-Eligibility Verification rule (CMS-9873-P), would apply beginning with 2028 health plans and does not change the open enrollment for 2027 coverage that begins November 1.
Under current policy, when a marketplace cannot electronically confirm something on an application, the enrollee enters an "inconsistency period" and keeps receiving subsidies while documentation is sorted out, with assistance reduced or ended if the paperwork never arrives. The proposed rule ends that practice. Four items would have to be verified before financial help starts: household income and family size; status as a citizen, U.S. national or eligible noncitizen; eligibility for or enrollment in other qualifying coverage such as Medicaid or a job-based plan; and place of residence. Consumers could still enroll in coverage without financial assistance while verification is pending.
To give people time to gather documents, marketplaces would open a pre-verification window each year starting August 1. The first window opens August 1, 2027, ahead of 2028 coverage. The rule implements Section 71303 of the Working Families Tax Cuts legislation (P.L. 119-21); the Treasury Department proposed matching premium tax credit regulations on October 15. The proposal was scheduled for Federal Register publication on October 27, followed by a 30-day public comment period.
"Federal subsidies should only go to eligible Americans, not to fraudsters gaming the system," said CMS Administrator Dr. Mehmet Oz. "Implementing the Working Families Tax Cuts legislation will protect taxpayer dollars and restore trust in the Exchanges by verifying eligibility before that money leaves the building." Treasury Secretary Scott Bessent said the companion rules "close eligibility loopholes." Open enrollment for 2027 coverage runs as planned from November 1, 2026, to January 15, 2027, with a December 15 deadline for coverage starting January 1.
Source: GSM · USA (original Chinese edition)
Photo: 美国卫生与公众服务部总部标识（资料图）。G. Edward Johnson 摄，CC BY 4.0，经 Wikimedia Commons。 / Signage at the U.S. Department of Health and Human Services headquarters (file photo). Photo by G. Edward Johnson, CC BY 4.0, via Wikimedia Commons.
