Current Federal Market Proposal Imposes New Necessities for States and Shoppers

By Sabrina Corlette and Jason Levitis*

On March 10, 2025, the Facilities for Medicare & Medicaid Providers launched a proposed regulation that makes a number of coverage and operational modifications to the Reasonably priced Care Act (ACA) Marketplaces and insurance coverage guidelines. A central tenet of the proposed rule is that Biden-era insurance policies to enhance Market premium affordability and ease administrative hurdles to enrollment have contributed to widespread fraudulent or in any other case improper enrollments. CMS makes use of this argument to justify modifications that would scale back Market premium tax credit, enhance paperwork necessities for candidates and enrollees, and roll again eligibility. The proposed rule doesn’t, nonetheless, acknowledge that improper enrollments are concentrated within the Federally Facilitated Market, despite the fact that most State-Primarily based Marketplaces (SBMs) adopted, and in lots of circumstances expanded upon, the insurance policies in query. Additional, whereas CMS acknowledges that broker-driven fraud is a key reason behind improper enrollment, the proposed rule doesn’t embody provisions that will impose limits on brokers’ habits or exert authority over lead mills and different actors driving fraudulent enrollments.

Of their newest Knowledgeable Perspective for the State Well being & Worth Methods program, CHIR’s Sabrina Corlette and the City Institute’s Jason Levitis present an evaluation of what the proposed rule means for SBMs and state insurance coverage regulators. The complete submit could be discovered right here.

*Jason Levitis is a Senior Fellow within the Well being Coverage Division on the City Institute.