The Centers for Medicare and Medicaid Services (CMS) released a regulatory proposal that would require health insurance markets to verify applicants' information before granting them federal subsidies, a change that would take effect starting with the 2028 coverage year.
The proposal, identified as CMS-9873-P and published in the Federal Register on October 27, outlines the eligibility changes established by the Working Families Tax Cut (WFTC) law, enacted on July 4, 2025. The deadline for submitting public comments is November 27, 2026.
Under the current rules of the Affordable Care Act (ACA) Marketplace, when an Exchange cannot electronically verify a claimant's data, they enter an "inconsistency period" during which they still receive financial assistance while submitting additional documentation.
The proposal would eliminate that practice. According to the official CMS document, the Exchanges should confirm four criteria before authorizing any advance payment of the premium tax credit (APTC) or cost-sharing reductions: household income and family size, citizenship or eligible immigrant status with legal presence, eligibility or enrollment in another qualifying medical coverage, and place of residence.
During the period in which verification is pending, the consumer may purchase a plan from the Marketplace, but they would pay the full price without a subsidy. CMS also proposes a "contingent plan" option that would only go into effect if eligibility for assistance is confirmed, even if open enrollment or the special enrollment period has already ended.
Another significant change would affect automatic re-enrollment. Those who are already enrolled would only retain their subsidies upon automatic renewal if they return to the Marketplace each year, confirm their information, and have it reverified. If they do not do so, they would be automatically re-enrolled but without financial assistance.
To facilitate the process, CMS proposes a verification window prior to the open enrollment period that would start on August 1st of each year. The first would correspond to August 1, 2027, for those seeking coverage in 2028.
The agency argues that verifying income before granting subsidies "could reduce the risk of consumers having to pay back excess amounts when filing their tax returns due to inaccurate income estimates," in addition to curbing fraudulent or improper enrollments.
It is essential to emphasize that this is a proposal, not a final rule.
Their provisions do not affect the open enrollment period that begins on November 1, 2026, for coverage in 2027. It also does not mean that losing financial assistance during verification automatically implies losing the ability to purchase a policy in the Marketplace.
For the Cuban community in the United States, which ranks among the groups with the highest usage of the Marketplace in Florida, the proposal adds to a series of regulatory changes that accumulated in October 2026.
Mid-month, CMS removed subsidies from 189,000 individuals identified with duplicate coverage in Medicare, Medicaid, or CHIP, or registered as deceased.
On that same day, the IRS and the Department of the Treasury published a proposal that eliminates the limits on excess APTC refunds starting from the 2026 fiscal year, which would require the total amount of the excess subsidy received to be repaid when filing the declaration in 2027.
The immigration statuses that can maintain eligibility for Marketplace subsidies include lawful permanent residents (green card holders) and those with the official designation "Cuban or Haitian entrant," as long as they meet the other income and residency requirements.
Those who wish to comment on the CMS-9873-P proposal have until November 27, 2026, to submit their feedback through the official Federal Register portal.
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