From Covering Kids & Families of Indiana Newsletter
The Centers for Medicare and Medicaid Services (CMS) proposed a new rule changing the enrollment procedures for the Affordable Care Act (ACA) Health Insurance Marketplaces.
Major provisions of the proposed rule, which would likely mean lower enrollment in the Marketplace overall, include:
- Ending the availability of the monthly special enrollment period (SEP) for individuals with household incomes below 150% of the federal poverty level (FPL).
- Shortening the annual Open Enrollment Period for individual market coverage offered through the ACA Marketplaces by ending it on December 15. (Currently, Open Enrollment is through January 15.)
In addition,
- CMS proposes a policy that would add sex-trait modification to the list of items and services that may not be covered as essential health benefits beginning in plan year 2026.
- The proposed rule would also revert to a previous definition of “lawfully present” that excludes Deferred Action for Childhood Arrivals (DACA) recipients for purposes of enrolling in Marketplace coverage.
View the 2025 Marketplace Integrity and Affordability Proposed Rule (CMS-9884-P) here.
Comments