On June 12, a Maryland federal judge vacated parts of CMS’ rule designed to govern marketplace integrity and affordability.
The excised provisions include the $5 premium penalty on automatic re-enrollees, revocations of guaranteed insurance for people with past-due premiums, eligibility verification for the special enrollment period, the failure-to-reconcile policy, shortened open enrollment beginning in 2027, the 60-day extension to address income inconsistencies, a requirement that exchanges confirm these inconsistencies when a tax filer’s attested projected income differs from “trusted data sources” and de minimis range changes for actuarial value calculations. An update to premium adjustment percentage calculations survived.
The rule aimed to protect against improper ACA enrollments. CMS finalized the rule in June 2025, with some policies limited to the 2026 plan year, but was met with a lawsuit from cities, as well as small business and healthcare organizations. Portions of the rule were put on hold in August.
“Eliminating coverage for an estimated 1.8 million people will drive up costs for the insured and lead to a significant decrease in the quality of care for the newly uninsured, which is unquestionably not in the public interest,” U.S. District Judge Brendan Hurson previously said.
HR 1, enacted over the summer, achieved similar ends to other parts of the rule through different means, such as by rendering individuals ineligible for premium tax credits if using the income-based special enrollment period.
Another lawsuit, filed in July by 21 Democratic states, challenged the rule’s provisions, as well.
Becker’s contacted CMS for comment and will update this story if more information becomes available.
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