HHS Issues Proposed Rules Making Access to the ACA More Restrictive

From the Center on Budget and Policy Priorities

This week, the Department of Health and Human Services (HHS) proposed a rule that, among other things, would make changes in special enrollment periods (SEPs), grace periods and the open enrollment period.  

These changes include: 

Pre-enrollment verification for SEPs: 

Our February 9 webinar on special enrollment periods included an overview of an upcoming pre-enrollment verification pilot program. Under this new process, people enrolling through an SEP will not be able to effectuate their coverage until the Marketplace verifies their eligibility for an SEP qualifying event. The proposed rule would expand pre-enrollment verification to all people newly enrolling in Marketplace coverage, and would apply to all categories of SEPs. The process would begin in June 2017. 

At this time, pre-enrollment verification is optional for State-Based Marketplaces that do not use Healthcare.gov, but HHS is asking for comments on whether this process should be a requirement for all states. 

We will present a webinar filling out the details on the new pre-enrollment verification process and other changes to SEP rules as soon as the rule is finalized. 

Changes to SEP qualifying events: 

Prior coverage requirement will be expanded. Under the proposed rule, to be eligible for the SEP triggered by marriage, at least one spouse will need to have had 1 day of minimum essential coverage in the 60 days prior to the marriage. 

Restrictions will be placed on plan selection for current Marketplace enrollees. Under the proposed rule, if a person already enrolled in Marketplace coverage is eligible for an SEP, they will only be able to use that SEP to change plans within the same metal level as their current plan, except in some limited cases. In addition, if an enrollee gains a dependent or gets married, that new dependent or spouse will only be allowed to be added to the enrollee’s current Marketplace plan, except in rare circumstances where the plan doesn’t cover dependents. Under the current rules, enrollees eligible for an SEP (and their dependents when applicable) can change their coverage to any other Marketplace plan at any metal level. 


Shortening open enrollment for 2018 coverage: 

The rule would significantly shorten the time people have to sign up for 2018 plans, ending open enrollment on December 15, 2017, instead of January 31, 2018. (Open enrollment would still start on November 1, 2017.) 


Change to grace period rules: 

The rule would allow an insurer to avoid enrolling a person whose coverage was terminated for non-payment of premiums in the past year unless that person pays the back premiums he or she owes the insurer. 

HHS is accepting comments on this proposed rule—Market Stabilization Rule (CMS-9929-P)—until March 7, 2017. You can submit comments: 

  • Electronically: Submit electronic comments at www.regulations.gov (for more information, see the “Submit a Comment” instructions under the help tab); or  
  • By mail: Submit written comments to Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-9929-P, P.O. Box 8016, Baltimore, MD 21244-8016. 


If you have any questions or concerns, please don’t hesitate to reach out to us at beyondthebasics@cbpp.org

Health Reform: Beyond the Basics is a project of the Center on Budget and Policy Priorities designed to provide training and resources that explain health coverage available through Medicaid, CHIP, and the Marketplace, and is intended for those working on the implementation of health reform. 


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