On March 10, 2025, the Centers for Medicare & Medicaid Services (CMS) released the Marketplace Integrity and Affordability Proposed Rule aimed at addressing improper enrollments in the Affordable Care Act (ACA) Health Insurance Marketplace. This is the first proposed rule released under the new Trump administration. If finalized, provisions in the proposed rule would go into effect in 2026.
CMS proposes to amend the definition of “lawfully present” to exclude Deferred Action for Childhood Arrivals (DACA) recipients. DACA recipients would no longer be eligible to enroll in a Qualified Health Plan through the Marketplace, for premium tax credits and for cost-sharing reductions. If finalized, this would reverse the 2024 final rule, bringing coverage to approximately 100,000 previously uninsured individuals.
Additionally, CMS proposes to remove the monthly special enrollment period for individuals with projected household incomes at or below 150% of the federal poverty level due to “erroneous and improper enrollment.” In the Association for Clinical Oncology’s (ASCO) view, if finalized, this proposal would make affordable health-care coverage difficult or even impossible to obtain, especially for individuals in states that have not expanded Medicaid.
Additional Policy Proposals
Other policy proposals in the rule include the following:
- Requiring all Marketplaces to reinstitute pre-enrollment verifications of eligibility for special enrollment periods and requiring further proof of income when there are no tax data available for verification.
- Shortening the annual open enrollment period for individual market coverage offered through ACA Marketplaces by ending it on December 15. It currently runs from November 1 to January 15.
- Requiring that when enrollees do not proactively verify their ongoing eligibility for a fully subsidized plan, Marketplaces must continue to re-enroll them into the same plan but must also reduce the amount of advance payment of the premium tax credit by $5.
According to the proposals, CMS expects approximately 750,000 to 2,000,000 individuals to lose coverage as a result of this rule. The agency goes on to state that coverage losses are expected to be concentrated in nine states where erroneous and improper enrollment is most noticeable—Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina, Tennessee, Texas, and Utah. It does, however, expect coverage losses across all states.
ASCO will continue to analyze the proposed rule and offer comments to the agency, which are due 30 days after the proposal is published in the Federal Register.
© American Society of Clinical Oncology. ASCO in Action. March 11, 2025. All rights reserved.
