Final Federal Marketplace Integrity Rule: Implications for States
By Sabrina Corlette and Tara Straw*
The Centers for Medicare & Medicaid Services (CMS) has finalized a set of policy and operational changes relating to the Affordable Care Act (ACA) and health insurance Marketplaces. The administration’s goals for these regulations are to change Marketplace eligibility and enrollment systems to prevent “waste, fraud and abuse,” reduce premiums for people ineligible for premium tax credits (PTC), and limit federal spending.
CMS received over 26,000 public comments on its draft rules, including from state government agencies, and representatives of insurers, providers, and consumers. The regulations are effective on August 25, 2025. Overall, the agency estimates that between 725,000 and 1.8 million people will lose insurance coverage in 2026 as a result of this rule. The rule is projected to reduce federal spending on PTCs by between $10.3 billion and $12.4 billion in 2026.
In a recent article for the Robert Wood Johnson Foundation’s State Health & Value Strategies project, CHIR’s Sabrina Corlette and Manatt Health’s Tara Straw dissect the final rule and its implications for state-based Marketplaces and state insurance regulators.
You can download the full article here.
*Tara Straw is a Senior Advisor at Manatt Health.
