Recent Federal Marketplace Proposal Imposes New Requirements for States and Consumers

By Sabrina Corlette and Jason Levitis*

On March 10, 2025, the Centers for Medicare & Medicaid Services released a proposed regulation that makes several policy and operational changes to the Affordable Care Act (ACA) Marketplaces and insurance rules. A central tenet of the proposed rule is that Biden-era policies to improve Marketplace premium affordability and ease administrative hurdles to enrollment have contributed to widespread fraudulent or otherwise improper enrollments. CMS uses this argument to justify changes that would reduce Marketplace premium tax credits, increase paperwork requirements for applicants and enrollees, and roll back eligibility. The proposed rule does not, however, acknowledge that improper enrollments are concentrated in the Federally Facilitated Marketplace, even though most State-Based Marketplaces (SBMs) adopted, and in many cases expanded upon, the policies in question. Further, while CMS recognizes that broker-driven fraud is a key cause of improper enrollment, the proposed rule does not include provisions that would impose limits on brokers’ behavior or exert authority over lead generators and other actors driving fraudulent enrollments.

In their latest Expert Perspective for the State Health & Value Strategies program, CHIR’s Sabrina Corlette and the Urban Institute’s Jason Levitis provide an assessment of what the proposed rule means for SBMs and state insurance regulators. The full post can be found here.

*Jason Levitis is a Senior Fellow in the Health Policy Division at the Urban Institute.