Court victory over Trump's CMS means final 2026 rate filings to be delayed...

If you've been following my state-by-state 2026 avg. rate change project, you may have noticed that after filling in the final, approved rate filings for a bunch of states over the past month or so, these tapered off to just three more last week (Illinois, Washington and Connecticut).

This may seem surprising since we're rapidly approaching the November 1st start date for Open Enrollment, but there's a good reason why final rulings seem to have dropped off: The Centers for Medicare & Medicaid Services (CMS) put out a bulletin last earlier this month which, among other things, extends the final deadline for individual market plan certifications in response to an order issued by a federal judge putting a stay on several important ACA exchange policy changes CMS is trying to put through:

...Pursuant to an order of the United States District Court for the District of Maryland in City of Columbus v. Kennedy, No. 25-cv-2114-BAH (D. Md.), the implementation of certain provisions of the recently promulgated Marketplace Integrity and Affordability Final Rule, 90 Fed. Reg. 27074 (June 25, 2025), has been stayed while the litigation remains pending. These provisions were scheduled to go into effect on August 25, 2025.

As a result of the court’s order, the following provisions of the final rule did not go into effect:

• The requirement that enrollees in fully subsidized Exchange coverage who fail to timely submit an application for an updated eligibility determination be subject to a $5 monthly premium until such an application is submitted, as reflected through the addition of 45 C.F.R. § 155.335(a)(3) and (n).

• The policy permitting issuers, subject to applicable state law, to decline to effectuate new coverage if a customer fails to pay premiums owed for prior coverage, as reflected through revisions to 45 C.F.R. § 147.104(i);c. d. e. f. g. The failure to reconcile policy in 45 C.F.R. § 155.305(f)(4), including the Marketplace Integrity and Affordability Final Rule’s amendments to that policy through the addition of 45 C.F.R. § 155.305(f)(4)(iii);

• The imposition of pre-enrollment eligibility verification requirements for all special enrollment periods, through revisions to 45 C.F.R. § 155.420(g);

• The imposition of a requirement that Exchanges verify household income inconsistencies when a tax filer’s attested projected annual household income differs from “trusted data sources,” through revisions to 45 C.F.R. § 155.320(c)(3)(iii)(A) and the addition of 45 C.F.R. § 155.320(c)(3)(vi)(C)(2);

• The imposition of a requirement that Exchanges verify a consumer’s annual household income when tax return data is unavailable, through revisions to 45 C.F.R. § 155.320(c)(5);

• The changes to the de minimis ranges for actuarial value calculations, through revisions to 45 C.F.R. §§ 156.140(c), 156.200(b)(3), and 156.400.

On August 29, 2025, the Department of Justice filed motions for a stay pending appeal on behalf of the U.S. Department of Health and Human Services in City of Columbus v. Kennedy (D. Md.). The motions ask the Maryland District Court and the United States Court of Appeals for the Fourth Circuit to stay the order with respect to the actuarial value policy under the Marketplace Integrity and Affordability Final Rule.

In the interim, absent any additional developments in the City of Columbus v. Kennedy litigation, issuers seeking certification of QHPs on the FFE (and SBEs-FP)0F may need to revise their plan designs for Plan Year 2026 and submit updated rate and form filings for Centers for Medicare & Medicaid Services (CMS) or state review. In particular, issuers that filed plans with actuarial values that took advantage of the expanded de minimis ranges at 45 C.F.R. §§ 156.140(c), 156.200(b)(3), and 156.400 under the Marketplace Integrity and Affordability Final Rule must submit updated rate and form filings and revise their QHP certification applications to reflect the allowable de minimis ranges under the court’s order. If these plans are not revised to be compliant with the allowable ranges, CMS will be unable to certify them for Plan Year 2026.

In other words, it could be several more weeks before any additional states publish their final 2026 rate filings, and it's possible that even some of the 19 which have already published theirs may end up revising them at the last minute after all.

I wouldn't expect any of these changes to have a huge impact on avg. 2026 rate hikes overall, but certain plans will shift around and you never know what the overall impact might be.

I should also note that none of this has anything to do with the potential extension of the enhanced Advance Premium Tax Credits being debated in the halls of Congress; if that happens (whether for one year, two years or permanently), it would cause massive changes to the rate filings, although I believe most carriers have already prepared alternate filings just in case that happens, so we'll see.

Stay tuned...

Appendix 1. QHP Data Change Window and Form and Rate Review Timeline

• QHP Data Change Window September 11 – 12, 2025

• Deadline for issuers in states without an Effective Rate Review Program to request CMS Rate Review deactivate QHP rate filings that require revisions: September 11, 2025

• Deadline for issuers in states where CMS is directly enforcing the ACA market-wide reforms to request CMS Form Filing reopen any QHP form flings that require revisions: September 11, 2025

• Deadline for issuers in states without an Effective Rate Review Program to submit revised QHP rate filings: September 16, 2025

• Deadline for issuers in FFE and SBE-FP states to submit a Data Change Request to CMS Plan Management: September 25, 2025

• CMS finalizes determinations for revised QHP rate filings from issuers in states without an Effective Rate Review Program: September 25 – 29, 2025

• Deadline for FFE and SBE-FP Effective Rate Review states to finalize determinations for revised QHP rate filings in SERFF: September 29, 2025

• Deadline for CMS to finalize review of revised QHP form filings: September 29, 2025

• Data Change Window for issuers in FFE and SBE-FP states with approved Data Change Requests to submit revised Rates Table Templates and other QHP Application Materials: September 30 – October 1, 2025

• Deadline for CMS to finalize determinations for revised rate filings containing only non-QHPs from issuers in states without an Effective Rate Review Program October 22, 2025Deadline for FFE and SBE-FP states with an Effective Rate Review Program to finalize determinations for rate filings containing only non-QHPs: October 22, 2025

• Deadline for Effective Rate Review states with a State-based Exchange that does not use the HealthCare.gov platform to finalize determinations for QHP and non-QHP rate filings: October 22, 2025

• Target date on which CMS will post all final rate changes: October 31, 2025

• Deadline for Effective Rate Review States to post all final rate increases, including those not subject to review (or link to ratereview.healthcare.gov for such information): October 31, 2025