Court Blocks Some ACA Changes Set to Become Effective 08/25/2025
This past Friday (8/22), a federal court temporarily halted CMS's ability to implement seven parts of the 2025 Marketplace Program Integrity and Affordability Final Rule, which alongside H.R.1 (the big federal budget bill), makes so many damaging changes to ACA eligibility and enrollment. CMS was going to implement a few of those seven provisions on August 25, 2025, but for now, because of the judge's order, the agency can't.
(In case it's helpful, here's the Center on Budget's review of H.R.1 and the Final Rule's coming changes to ACA policy.)
The judge halted the following changes, so they will NOT take effect as planned:
Requiring people to submit income verification if they attest to income that would make them eligible for PTC, but federal databases show income less than 100% FPL (formerly effective August 25, 2025).
Requiring people to submit income verification if no tax data is available (formerly effective August 25, 2025).
Allowing insurers to require people to pay past-due premiums as a condition of enrolling in a marketplace plan offered by that issuer in the future (formerly effective August 25, 2025).
Charging a $5 fee to people enrolled in plans with $0 premiums that do not actively reenroll (in other words, automatically reenroll) in coverage (formerly effective Open Enrollment for Plan Year 2026).
Changing “de minimis” amounts, enabling insurers to offer plans with actuarial values below the standard value (formerly effective Plan Year 2026).
Requiring additional verification for commonly used SEPs (formerly effective Plan Year 2026)
Determining people ineligible for PTC if the tax file failed to reconcile their APTCs on their tax returns for one year (formerly effective Plan Year 2026).
Some changes will continue to take effect as planned (all effective August 25, 2025):
Eliminating the year-round low-income special enrollment period (SEP) for people with incomes at or below 150 percent FPL in all states.
Prohibiting marketplaces from granting applicants an automatic 60-day extension to the 90-day period to resolve income inconsistencies.
DACA recipients no longer be eligible for Marketplace coverage or PTCs. September 30, 2025 is the last day of coverage for DACA recipient enrollees.
The most important things to make sure application assisters are clear on right now are:
The three changes that are still starting today.
If clients or patients are enrolling right now via SEP, insurance companies cannot require people to pay past-due premiums before they pay for their current premium in a Marketplace plan they enroll in. If insurance companies try to prevent people from paying their first month's premium because of a missed payment in the past, reach out to Every Texan's Director of Health and Food Justice, Lynn Cowles, so she can help troubleshoot and contact insurance company administrators to fix the problem. Lynn's at 512-522-3220 or [email protected].
CTN will share more as the case makes its way through the courts and policies shift again.