CMS said Sept. 22 that it canceled plan year 2026 ACA policies covering 760,000 people.
CMS canceled 315,000 policies covering these individuals Aug. 31. According to federal rulemaking records — set to publish in the Federal Register on Sept. 23 — these people enrolled with agent or broker help but lacked verified citizenship or immigration documentation. Policy issuers could not identify claims or contact these consumers, either. During a Sept. 22 press conference, Vice President JD Vance said the government will do “additional verification” concerning legal status and income for 419,000 people.
In a Sept. 22 news release, CMS said it is anticipating a return of about $2.2 billion in advance payments of the premium tax credit. The removals were spearheaded by the White House Task Force to Eliminate Fraud.
CMS is also temporarily freezing new agent and broker registrations with federally facilitated exchanges for plan year 2027. This pause will be in effect until Feb. 1. The rulemaking documents said that based on two methodologies, agent and broker noncompliance leading to unauthorized enrollment could amount to roughly $1.5 billion or $6.6 billion in annual improper federal spending.
“Temporarily pausing the registration of new agents and brokers narrowly targets the category of agents and brokers that CMS has determined warrant additional scrutiny, while allowing CMS time to implement additional safeguards designed to prevent unauthorized enrollments and other noncompliant practices before new agents and brokers begin assisting consumers on the federally-facilitated exchanges,” the rulemaking document said.
In the release, CMS said it will take on further work with insurance companies to address what may be unauthorized enrollments, focus on terminating noncompliant brokers and agents, and carry out other integrity efforts.
The interim final rule, including the registration freeze, goes into effect immediately. Despite bypassing the advance notice-and-comment period, HHS said it would still consider public comments. The rulemaking also bakes in an HHS authority to implement temporary freezes on agent and broker registrations when “conduct poses an unacceptable risk,” as well. CMS has taken steps to crack down on broker noncompliance in past rulemaking.
In July and August, CMS sent 569 notices to agents and brokers, indicating possible termination of exchange agreements. According to CMS’ rulemaking documents, these agents and brokers “submitted statistically implausible rates” of applications for plan year 2026 without applicants’ important identifying details, such as Social Security numbers.
Looking at plan year 2026, CMS said new registrants accounted for 30% of those 569 agents and brokers whose activity suggested possible violations of exchange standards. However, these new registrants made up only about 11% of all registered agents and brokers with at least one active enrollment for the plan year.
The release said that since the start of 2026, CMS has issued termination notices addressing more than 200 agents and brokers it identified as noncompliant.
“Addressing healthcare fraud is critical to rooting out waste in the system. At the same time, Americans across the country are being priced out of health insurance and losing coverage as a result,” Charlene MacDonald, president and CEO of the Federation of American Hospitals, said in a statement shared with Becker’s. “Hospitals are already seeing the consequences in their emergency rooms — when patients lose coverage, they often delay care until they are sicker, which puts upward pressure on costs across the healthcare system. We need to tackle fraud while also ensuring hardworking Americans have access to affordable coverage.”
The rule comes as ACA enrollment dropped in 2026 following the expiration of enhanced subsidies. Open enrollment for 2027 begins Nov. 1.
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