ACA Marketplace Coverage in Texas: CMS Proposes Verifying Eligibility Before Subsidies Begin, With a New Pre-Open-Enrollment Window Starting August 1, 2027

What Changed, and When

The document is a proposed rule, not a final one. It is titled Patient Protection and Affordable Care Act, Exchange Pre-Eligibility Verification. The issuing agency is the Centers for Medicare & Medicaid Services (CMS) within the Department of Health and Human Services. It was published in the Federal Register on Tuesday, October 27, 2026 at 91 FR 67656, Volume 91, Number 206, as document 2026–21891, under file code CMS–9873–P and RIN 0938–AW03. It would amend 45 CFR part 155.

The rule states its own purpose plainly: it would update Exchange eligibility and verification rules “consistent with new requirements specified under section 71303 of Public Law 119-21 (July 4, 2025), which we refer to as the Working Families Tax Cut (WFTC) legislation.” In other words, Congress set the requirement in statute in July 2025; this proposal is the agency working out how Exchanges would carry it out.

The core change is the order of operations. Today, an Exchange can generally pay advance premium tax credits (APTC) and cost-sharing reductions (CSRs) while a documentation question is still being worked out. Under the proposal, as the rule describes it, “beginning with PY 2028, an Exchange must verify eligibility for enrollment in a QHP and APTC using the following information before a month is considered a coverage month and PTC may be paid: (1) household income and family size; (2) eligible noncitizen status; (3) any health coverage status or eligibility for coverage; (4) residency; and (5) other information as determined by the Secretary of the Treasury, in consultation with the Secretary of HHS.”

Automatic re-enrollment with financial help would change too. The proposal would amend 45 CFR 155.335 so that an Exchange “may not redetermine an enrollee eligible for APTC and CSRs for the subsequent plan year unless the enrollee or the enrollee’s application filer provides or confirms household income and family size; U.S. citizenship or status as an eligible noncitizen; eligibility for or enrollment in other MEC; and place of residence for the subsequent plan year on or after August 1 and no later than December 31 of the year preceding the applicable plan year.” CMS states that an enrollee who does not do so would be re-enrolled in coverage without financial assistance.

A new verification window opens before Open Enrollment. The proposal would require every Exchange to let consumers provide eligibility information for the coming plan year before Open Enrollment begins, “beginning on August 1, 2027, for PY 2028 and August 1 of each subsequent year.”

Dates that are in the document. The provisions would first apply to plan year 2028. The first pre-open-enrollment verification period would open August 1, 2027. The comment period on the proposal closes November 27, 2026: the rule states that “[t]o be assured consideration, comments must be received at one of the addresses provided below, by November 27, 2026,” under file code CMS–9873–P. Because this is a proposal, the text can change before any final rule issues.

Who in Texas This Reaches

The rule is national and contains no Texas-specific text, but the population it describes is concentrated here. According to CMS Marketplace data reported for the 2026 Open Enrollment Period, 4,113,465 Texans had selected a Marketplace plan as of January 3, 2026 — more than in any other state. Texas uses the federally facilitated Exchange at HealthCare.gov, so a federal Exchange rule is the operating rule for Texas enrollees.

• Texans who receive advance premium tax credits or cost-sharing reductions. The proposal is about the financial help, not the right to buy a plan. CMS states that a consumer “must not be treated as ineligible to enroll in a QHP solely for failing to meet the requirements of section 36B(c)(5) of the Code for a month.”
• Households whose income is hard to document electronically — self-employed Texans, gig and contract workers, seasonal and agricultural workers, and anyone whose income changed mid-year. These are the households most likely to land in what the rule calls an inconsistency period.
• Lawfully present immigrants and mixed-status households. “Eligible noncitizen status” is one of the four criteria that would have to be verified before the help is paid, which makes immigration paperwork and Marketplace paperwork touch each other more directly than they do now.
• People who move, including within Texas. Place of residence is on the list of items to be verified.
• Anyone who has relied on being re-enrolled automatically. Under the proposal, silence between August 1 and December 31 would mean re-enrollment without financial assistance rather than with it.
• Texans who are not asking for financial help at all. CMS states the changes would not affect consumers who do not apply for or are not eligible for financial assistance.

What This Changes Legally

Three things in the proposal are worth separating, because the document keeps them separate.

• The statute, not the agency, created the verification condition. Section 71303(a) of the Working Families Tax Cut legislation amended the definition of a coverage month in section 36B of the Internal Revenue Code and, as CMS puts it, “conditions PTC eligibility on successful verification of applicable enrollment information.” The proposed rule is the implementation of that statutory change.
• Enrollment and financial help come apart. A consumer could still select and enroll in a plan while verification is pending; what the proposal would withhold during an unresolved inconsistency period is the subsidy. CMS also proposes that where verification later succeeds, financial assistance can be applied retroactively to the inconsistency-period months the person was enrolled, and sets out proposed effective-date rules for when it starts.
• Reported changes mid-year are treated asymmetrically. Where an enrollee reports a change that would raise or keep the same amount of help, CMS proposes that Exchanges “would be required to continue providing APTC and CSRs (as applicable) during inconsistency periods at the same amount as previously determined.” Where the reported change points to a lower amount, Exchanges “would lower APTC and CSRs based on the information provided by the applicant during an inconsistency period.”

One related change sits outside this rule but in the same statute, and it matters for anyone doing the arithmetic: CMS notes that section 71305 of the Working Families Tax Cut legislation “eliminated the limitation on repayment of excess APTC for tax years after December 31, 2025.” Repayment caps that once limited how much of an overpaid subsidy had to be paid back at tax time no longer apply to those years.

What Kind of Option Might Apply

Nothing in this proposal requires an ordinary enrollee to file anything this month, and no one should read it as a statement about whether a particular person qualifies for anything. What it does is describe the paperwork landscape Texas households are heading into, and there are places where a lawyer is useful well before 2028.

• A subsidy that stopped, or a plan that terminated. Marketplace eligibility determinations carry appeal rights. An attorney can review the notice, the deadline printed on it, and the record behind the determination.
• A demand to repay advance premium tax credits. With the repayment limitation removed for tax years after December 31, 2025, the amounts at stake can be larger than people expect. A tax or health care attorney can look at how the figure was calculated.
• Immigration status documents that do not match. Where a Marketplace record and an immigration record disagree, an immigration lawyer can review the underlying status documents, and the two problems are often best handled together.
• A denial that looks like it rests on bad data. The rule is built on electronic data matching against federal sources. Where those sources are wrong, the question is evidentiary, and an attorney can advise on what documentation carries weight.

Each of these turns on one person’s facts and one set of notices. An experienced Texas attorney can review them and explain the options; this page cannot, and does not try to.

Why Acting Quickly Can Matter

The dates in this proposal are far enough out to be useful rather than alarming. The requirements would first bite for plan year 2028, and the first pre-open-enrollment verification window would open on August 1, 2027 — roughly nine months from now. That is time to gather documents rather than to scramble for them.

The deadlines that are short are the ones already printed on notices people are holding today. A Marketplace eligibility notice, a termination notice, and a tax notice about advance premium tax credits each carry their own appeal or response window, and those windows run from the date on the document, not from this rule. Where one of those notices is in hand, it is best to have a lawyer look at it while its own deadline is still open.

If a lawyer in our network offers an initial consultation, it is free.

Sources

1. Patient Protection and Affordable Care Act, Exchange Pre-Eligibility Verification, proposed rule, Centers for Medicare & Medicaid Services, Department of Health and Human Services — 91 FR 67656, Federal Register Vol. 91, No. 206, October 27, 2026; document 2026–21891; file code CMS–9873–P; RIN 0938–AW03 (primary document).
2. Exchange Pre-Eligibility Verification — Federal Register online edition of the same proposed rule, including the November 27, 2026 comment deadline.
3. Exchange Pre-Eligibility Verification Proposed Rule (CMS-9873-P), CMS fact sheet, October 23, 2026.
4. CMS Proposes New Verification Requirements to Implement Law that Combats Exchange Fraud and Protects Taxpayer Dollars, CMS press release, October 23, 2026.
5. Texas ACA enrollment hits record high in 2026, Texas 2036, January 13, 2026 — reporting the CMS figure of 4,113,465 Texas Marketplace plan selections as of January 3, 2026.
6. ACA marketplace subsidy verification proposed rule, Healthcare Financial Management Association — independent coverage of the proposal and its plan-year 2028 applicability.