On August 22, 2025, just days before the Centers for Medicare & Medicaid Services (CMS) Program Integrity Rule was scheduled to take effect, a federal judge temporarily halted portions of the changes.
U.S. District Judge Brendan Hurson of Baltimore sided with a challenge brought by the City of Chicago, the Mayor and City Council of Baltimore, and public health advocates. The plaintiffs argued that implementing the rule would impact more than 2 million people by raising fees and creating new barriers, ultimately causing many to lose their health coverage.
Until a final ruling is issued in the case against CMS, Judge Hurson has paused nearly all of the new Marketplace Integrity and Affordability Rule provisions, including:
SEP pre-enrollment verification
The $5 premium for $0 passive renewals
Certain Data Matching Issue (DMI) requirements
These provisions were set to take effect on August 25, 2025, with CMS stating they were intended to prevent improper enrollments and misuse of federal funds. In his ruling, Judge Hurson noted that the states had presented sufficient evidence that the new provisions may conflict with the Affordable Care Act (ACA).
CMS is expected to issue guidance for the 2026 OEP—we’ll share updates as soon as we have them.
