The Centers for Medicare & Medicaid Services (CMS) has proposed new eligibility verification requirements for people seeking financial assistance through Affordable Care Act (ACA) health insurance marketplaces, aiming to reduce improper enrollments and protect taxpayer funds.

The proposed rule would require marketplaces to verify key eligibility information before providing advance premium tax credits and income-based cost-sharing reductions. Information subject to verification would include household income and family size, citizenship or eligible immigration status, enrollment in other qualifying coverage, and residency.

Under the proposal, consumers whose eligibility information cannot be verified could still enroll in marketplace coverage while documentation is pending, but they generally would not receive financial assistance during that period. Currently enrolled consumers also would need to confirm and reverify certain eligibility information annually to be automatically reenrolled with subsidies. Those who do not complete the process could be reenrolled without financial assistance.

The changes would apply beginning with the 2028 plan year. CMS proposes an early verification period starting Aug. 1, 2027, giving consumers more time to confirm eligibility before open enrollment.

The proposal implements provisions of the Working Families Tax Cuts legislation. CMS is accepting public comments for 30 days following publication of the proposed rule.