The ACA and the New Administration: CMS Proposed Rule Impacting Marketplace Eligibility and Other Notable Actions

The Trump administration has taken recent action related to the ACA that will impact millions, including rescinding Biden-era measures that increased ACA enrollment, slashing funding for ACA navigators, and issuing a proposed rule that will significantly impact ACA eligibility and enrollments across the country. 

The CMS proposed rule, one of the most notable actions, purportedly taken to crack down on fraud in the program, would shorten the annual open enrollment period by one month, end the availability of the monthly special enrollment period (SEP) for individuals with household incomes below 150 percent of the federal poverty level, and require all marketplaces to reinstitute pre-enrollment verifications of eligibility for SEPs and further verifications of income when there is no tax data available for verification.

Additionally, the proposed rule would further administration priorities by adding sex-trait modification to the list of services that may not be covered as essential health benefits beginning in plan year 2026; and would revert to a previous definition of "lawfully present" that excludes DACA recipients for purposes of enrolling in marketplace coverage.

Critics of the proposed rule claim its effect will be to shrink participation in the exchanges. And any impact on fraud will be minimal as the proposed rule only nominally affects agents and brokers, while the prior administration's rule made it more difficult for insurance agents to make unauthorized changes to consumers' coverage and expanded CMS' ability to punish bad actors.

Listen as our expert panel closely examines the new administration's actions related to the ACA including the recently proposed rule aimed at maintaining the integrity of the ACA. The panel will provide insight into the potential impact on the healthcare industry and offer best practices for compliance.

I.      Introduction: new administration and the ACA

II.    Rescinding Biden-era measures

III.   Funding cut for ACA navigators

IV.  CMS proposed rule related to ACA eligibility and enrollment

A.    Purpose

B.    Proposed changes

1.    Addressing improper enrollments

2.    Furthering administration policies

V.    Impact on healthcare industry and marketplace participants

VI.  Practitioner takeaways

The panel will review these and other important considerations:

• The new administration has taken what policy actions related to the ACA?
• What are key changes in the proposed CMS rule that will impact ACA eligibility and enrollment?
• How do the proposed rule changes advance the new administration's healthcare agenda?
• What is the potential impact of the administration's actions on healthcare providers and ACA marketplace participants?