From publishing an interim final rule for Medicaid work requirements to proposing a cap on state Medicaid payments, here are seven final and proposed rules issued by CMS in 2026:
Editor’s note: This is not an exhaustive list.
1. CMS on June 1 published its interim final rule for state implementation of Medicaid work requirements. CMS did not issue a proposed rule for these requirements. HR 1 directed the agency to implement them through an interim final rule, a route that lets the regulation take effect without the usual notice-and-comment rulemaking. The rule is effective July 31, 2026 — the same day public comments are due — and CMS is not obligated to substantially revise it before states begin carrying it out.
2. CMS on May 20 proposed a rule that would cap certain state Medicaid payments and align them more closely with Medicare rates. The proposed rule would create new limits for Medicaid state-directed payments and certain fee-for-service payments to reduce Medicaid spending by more than $775 billion over 10 years, including $510 billion in federal savings.
3. CMS on May 15 finalized a broad set of changes to the ACA marketplace that will affect how insurers design plans, how eligibility is verified, and who qualifies for federal subsidies. The rule eliminates the federal-exchange standardized-plan requirement and the cap on non-standardized plans, reinstates pre-enrollment verification for at least 75% of new special-enrollment-period sign-ups, and bars counting routine adult dental as an essential health benefit. Aligning with HR 1, it narrows premium tax credit eligibility to citizens and a limited set of lawful immigrants starting in 2027 and lowers the federal exchange user fee to 1.9% for 2027.
4. CMS on April 10 published its fiscal 2027 Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System proposed rule, which includes a 2.4% payment increase for hospitals as well as the first mandatory nationwide episode-based payment model. CMS plans to expand the Comprehensive Care for Joint Replacement Model into a mandatory, nationwide program called CJR-X, set to begin Oct. 1, 2027.
5. CMS on April 2 released four fiscal 2027 proposed payment rules covering skilled nursing facilities (+2.4%), hospices (+2.4%, about $785 million, with the 2027 aggregate cap set at $36,210.11), inpatient psychiatric facilities (+2.3% rate increase and +2.1% total payment increase, about $50 million) and inpatient rehabilitation facilities (+2.4%, about $355 million). Notable provisions include a new hospice Service and Spending Variation Index, a 20% facility-level outlier payment cap for inpatient psychiatric facilities and a request for information on Patient-Driven Payment Model upcoding.
6. CMS on April 2 published its final 2027 Medicare Advantage and Part D rule, enacting changes to star ratings, supplemental benefits administration and Part D coverage, along with a series of deregulatory provisions; the rule is effective June 1 and applies to coverage beginning in 2027. CMS declined to implement the Excellent Health Outcomes for All reward (formerly the Health Equity Index) and finalized removing 11 star ratings measures it deemed administrative or low-variation. It added a new MA depression screening and follow-up measure (2027 measurement year, 2029 star ratings) and finalized supplemental benefit debit card guardrails requiring real-time point-of-sale verification.
7. CMS on Jan. 1 rolled out the Wasteful and Inappropriate Service Reduction initiative that adds prior authorization for some traditional fee-for-service Medicare services. Under the model, CMS partners with companies specializing in AI and machine learning to test ways to provide an improved and expedited prior authorization process for certain Medicare services. The model is being tested in Arizona, Washington, New Jersey, Texas and Oklahoma.
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