Verification of Applicant Information Proposed Before Granting Subsidies in Health Insurance Markets by 2028

The Centers for Medicare and Medicaid Services (CMS) have introduced a regulatory proposal aiming to require health insurance marketplaces to verify applicant information before awarding federal subsidies. This change is slated to take effect starting with the 2028 coverage year.

Known as CMS-9873-P, the proposal was published in the Federal Register on October 27, building upon eligibility changes outlined in the Working Families Tax Cut (WFTC) law, which was signed into law on July 4, 2025. The deadline for public comments is set for November 27, 2026.

Under the current Affordable Care Act (ACA) Marketplace rules, if an Exchange cannot electronically verify an applicant’s data, the individual enters a "period of inconsistency" during which they still receive financial assistance while providing additional documentation.

This proposal seeks to eliminate that practice. According to the CMS document, Exchanges must verify four criteria before authorizing any advance payment of the premium tax credit (APTC) or cost-sharing reductions: household income and family size, citizenship or eligible immigration status with legal presence, eligibility or enrollment in other qualifying health coverage, and residence.

While verification is pending, consumers could still purchase a plan from the Marketplace but would have to pay the full price without subsidies. CMS also suggests a "contingent plan" option that would only activate if eligibility for assistance is confirmed, even if open enrollment or the special enrollment period has ended.

Another notable change involves automatic re-enrollment. Those already enrolled would only retain their subsidies upon automatic renewal if they return to the Marketplace each year, confirm their data, and have it re-verified. Failure to do so would result in automatic re-enrollment without financial assistance.

To streamline the process, CMS proposes a verification window prior to open enrollment, starting each August 1. The first would be on August 1, 2027, for those seeking coverage in 2028.

The agency argues that verifying income before granting subsidies could "reduce the risk of consumers having to repay excess amounts when filing taxes due to inaccurate income estimates," as well as curb fraudulent or improper enrollments.

It is crucial to note that this is a proposal, not a final rule. Its provisions do not affect the open enrollment starting November 1, 2026, for 2027 coverage. Additionally, losing financial assistance during verification does not automatically mean losing the ability to purchase a Marketplace policy.

For the Cuban community in the United States, among the largest users of the Marketplace in Florida, the proposal adds to a series of regulatory changes accumulated by October 2026.

Mid-month, CMS withdrew subsidies from 189,000 individuals identified with duplicate coverage in Medicare, Medicaid, or CHIP, or registered as deceased.

On the same day, the IRS and the Treasury Department proposed eliminating the repayment caps on excess APTC starting in the 2026 tax year, requiring full repayment of any excess subsidy when filing taxes in 2027.

Immigration statuses that maintain eligibility for Marketplace subsidies include lawful permanent residents (green card holders) and those with the official "Cuban or Haitian entrant" status, provided they meet other income and residency requirements.

Those wishing to comment on the CMS-9873-P proposal have until November 27, 2026, to submit feedback through the official Federal Register portal.