Regulatory Analysis | Jun 27, 2025

Final Federal Marketplace Integrity Rule: Implications for States

Sabrina Corlette, Georgetown Center on Health Insurance Reforms; and Tara Straw, Manatt Health

The Centers for Medicare & Medicaid Services (CMS) has finalized a set of policy and operational changes relating to the Affordable Care Act and health insurance Marketplaces, effective August 2025. The administration’s goals for these regulations are to change Marketplace eligibility and enrollment systems to prevent waste, fraud and abuse, reduce premiums for people ineligible for premium tax credits (PTC), and limit federal spending. CMS estimates that as a result of the rule, between 725,000 and 1.8 million people will lose insurance coverage in 2026 and federal spending on PTCs will be reduced between $10.3 billion and $12.4 billion in 2026. This regulatory analysis summarizes the provisions of the rule and highlights considerations for state officials.


Expert Perspectives

May 22, 2026

The Power of Transparency: How States Can Use Data Dashboards to Effectively Monitor H.R. 1

H.R. 1 will bring wide-reaching changes to the Medicaid program and as these provisions take effect, states will face questions about how the changes are impacting both the Medicaid program and the individuals who rely on it for coverage. This expert perspective outlines the case for state H.R. 1 data dashboards, provides practical design guidance, and highlights successful examples of recent state dashboards.