CMS Proposes Rule to Combat Improper ACA Enrollments

On March 10, the Centers for Medicare & Medicaid Services (CMS) introduced a proposed rule aimed at reducing improper enrollments in the Affordable Care Act (ACA) Health Insurance Marketplaces. This new rule seeks to protect individuals from being enrolled without their knowledge and aims to ensure that financial assistance is provided only to those intended by the ACA.

The CMS highlighted a significant increase in complaints regarding unauthorized enrollments, with research indicating that up to 4 to 5 million people were improperly enrolled in subsidized ACA coverage in 2024, resulting in potential costs of $20 billion to federal taxpayers.

If approved, the rule would shorten the open enrollment period and alter the special enrollment options, particularly for those with very low incomes, thereby encouraging continuous enrollment rather than allowing people to enroll only when they become ill. Additionally, the rule proposes reinstating certain policies from the previous administration, including changes to coverage for essential health benefits and eligibility for DACA recipients.