The ACA and the New Administration: CMS Proposed Rule Impacting Marketplace Eligibility and Other Notable Actions

Description

The Trump administration has taken recent action related to the ACA that will impact millions, including rescinding Biden-era measures that increased ACA enrollment, slashing funding for ACA navigators, and issuing a proposed rule that will significantly impact ACA eligibility and enrollments across the country. 

The CMS proposed rule, one of the most notable actions, purportedly taken to crack down on fraud in the program, would shorten the annual open enrollment period by one month, end the availability of the monthly special enrollment period (SEP) for individuals with household incomes below 150 percent of the federal poverty level, and require all marketplaces to reinstitute pre-enrollment verifications of eligibility for SEPs and further verifications of income when there is no tax data available for verification.

Additionally, the proposed rule would further administration priorities by adding sex-trait modification to the list of services that may not be covered as essential health benefits beginning in plan year 2026; and would revert to a previous definition of "lawfully present" that excludes DACA recipients for purposes of enrolling in marketplace coverage.

Critics of the proposed rule claim its effect will be to shrink participation in the exchanges. And any impact on fraud will be minimal as the proposed rule only nominally affects agents and brokers, while the prior administration's rule made it more difficult for insurance agents to make unauthorized changes to consumers' coverage and expanded CMS' ability to punish bad actors.

Listen as our expert panel closely examines the new administration's actions related to the ACA including the recently proposed rule aimed at maintaining the integrity of the ACA. The panel will provide insight into the potential impact on the healthcare industry and offer best practices for compliance.