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CMS proposes heightened standards for ACA financial assistance

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CMS proposes heightened standards for ACA financial assistance

Enrollees must jump through more hoops to verify information about their income and residency status.

The second Trump administration has made cracking down on the ACA a priority — freezing registrations for new brokers, cutting more than 700,000 purportedly unauthorized enrollments and enacting stricter eligibility checks for people seeking coverage — all in the name of rooting out what officials say is rampant fraud.

Officials in the Trump administration said Friday’s new policies were “common-sense reforms” meant to safeguard taxpayers dollars.

“Hardworking American taxpayers should not be forced to subsidize health care for people who are ineligible under federal law,” Treasury Secretary Scott Bessent said in a statement.

​​​​​Currently, individuals qualify for premium tax credits if their household income is between 100% and 400% of the federal poverty level, and for cost-sharing reductions if it’s between 100% and 250%.

People are required to provide qualifying information to the CMS to receive financial assistance, though the agency lets enrollees reap the savings for a period of time before it’s able to verify that information.

The latest regulation would close that loophole. Starting in plan year 2028, the agency would need to verify household income and family size, citizenship status, residency and eligibility for other health coverage before enrollees can receive financial assistance.

It also would require enrollees to verify that information annually to continue receiving financial help. The CMS proposed creating a new verification period, starting Aug. 1 each year before open enrollment begins.

The CMS said its goal is to make sure consumers have enough time to share and confirm their eligibility before the next plan year begins.


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