The Centers for Medicare & Medicaid Services (CMS) published a proposed rule, “Exchange Pre-Eligibility Verification” (CMS-9873-P, 91 FR 67656), on 27 October 2026. It would carry out section 71303 of Public Law 119-21, which CMS calls the Working Families Tax Cut (WFTC) law. Most changes would apply to plan years starting on or after 1 January 2028.

Main proposals

  • No subsidy during unresolved mismatches. Exchanges could not pay advance premium tax credits (APTC) or cost-sharing reductions while an applicant has an unresolved data-matching issue on citizenship or lawful presence, residency, household income, family size, eligible-noncitizen status, or other coverage (Medicaid or an employer plan). Today, people generally receive subsidies during the inconsistency period. Households using certain special enrollment periods, those for gaining or becoming a dependent, would be exempt.
  • No automatic subsidy renewal. Exchanges could not redetermine someone eligible for next year’s subsidy unless they provide or confirm income, family size, citizenship or eligible-noncitizen status, other coverage and residence between 1 August and 31 December of the prior year.
  • A new pre-open-enrollment verification window opening 1 August each year.
  • “Pended” plan selections: consumers could choose a plan that only takes effect once subsidy eligibility is confirmed. Coverage start dates would depend on when mismatches are resolved.
  • CMS asks for ideas on moving away from accepting self-attestation of residency, and on tightening family-size checks.

CMS’s own numbers

  • Enrollment falls by an estimated 237,500 on the federal platform and 95,000 across the 22 State Exchanges, 332,500 in total (our sum).
  • APTC spending falls about $2.6 billion a year from that enrollment drop, plus about $5 billion from subsidies starting about 1.5 months later for people who verify, roughly $7.6 billion a year from plan year 2028. CMS uses an average subsidy of $655 a month.
“Increased verification-related barriers to enrollment, leading to a decrease in enrollment…” — CMS accounting table, CMS-9873-P
Citizen impact: Taxpayers spend less on subsidies. People whose citizenship, income or residence records don’t match government data, often because of job changes, new immigration status or moves, would pay full price or wait until they are verified. Everyone receiving a subsidy would have to actively confirm their details each year. Comments close 27 November 2026 at regulations.gov docket CMS-2026-3367.

What this piece refuses

We do not claim the rule targets illegal immigrants specifically: the checks cover citizenship and lawful presence alongside income, residency and other coverage. We do not report how many current enrollees are ineligible; CMS gives no such figure in the summary we read.

Bottom line

Under this proposal, ACA subsidies would no longer be paid before checks are done. CMS estimates about $7.6 billion a year saved and about 332,500 fewer people covered from 2028. It is still a proposal; comments close 27 November.