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HHS/CMS RIN: 0938-AW03 Publication ID: 2026 
Title: ●Exchange Pre-Enrollment Eligibility Verification (CMS-9873)(Section 610 Review) 
Abstract:

Public Law 119-21, known as the Working Families Tax Cut (WFTC) Legislation, amended the Internal Revenue Code (26 U.S. Code 36B) to establish new requirements for Federal and State-based Exchanges regarding eligibility verification for the premium tax credit (PTC). As a result, all Exchanges must verify certain eligibility criteria for individuals seeking coverage through a qualified health plan (QHP) with the advance premium tax credit (APTC) before an individual is eligible for APTC. This new policy changes existing policy established by Affordable Care Act Section 1411(e)(4)(B)(i) that allowed the Exchange to provide APTC for a set period of time to individuals who needed to submit documentation to verify their eligibility. Beginning with plan year 2028, individuals will not receive APTC until they have successfully verified their eligibility through a documentation submission process. Given that the Open Enrollment Period for plan year 2028 begins November 1, 2027, these requirements must be implemented before this date. Public Law 119-21 also establishes an additional requirement beginning August 1, 2027, for all Exchanges to provide a pre-enrollment verification process no later than August 1st of the year preceding the plan year. At a minimum, this process must allow individuals to verify their income and eligibility for a QHP for the upcoming plan year. If an Exchange fails to provide this process, no individual enrolled through that exchange will be eligible for PTC. This proposed rule would outline how Exchanges will implement these new statutory requirements.

 
Agency: Department of Health and Human Services(HHS)  Priority: Economically Significant 
RIN Status: First time published in the Unified Agenda Agenda Stage of Rulemaking: Proposed Rule Stage 
Major: Yes  Unfunded Mandates: No 
EO 14192 Designation: Other 
RFA Section 610 Review: Section 610 Review 
CFR Citation: None     (To search for a specific CFR, visit the Code of Federal Regulations.)
Legal Authority: 26 U.S.C. 36B(c)(3)(A) (Pub. L 119-21 sec. 71303)    26 U.S.C. 36B(c)(5) to (c)(6) (Pub. L 119-21 sec. 71303)   
Legal Deadline:  None
Timetable:
Action Date FR Cite
NPRM  07/00/2026 
Regulatory Flexibility Analysis Required: YES  Government Levels Affected: Federal, State 
Small Entities Affected: Businesses  Federalism: No 
Included in the Regulatory Plan: No 
RIN Data Printed in the FR: Yes 
Related Agencies: Joint: TREAS/IRS; 
Agency Contact:
Jeff Wu
Deputy Director for Policy
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Center for Consumer Information and Insurance Oversight, 7500 Security Boulevard,
Baltimore, MD 21244
Phone:301 492-4305
Email: jeff.wu@cms.hhs.gov