Plaintiffs, three cities, a coalition of doctors, and an interest group representing small business owners, challenged certain provisions of the HHS Final Rule titled “Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability,” alleging they will shoulder increased costs or see their members lose health insurance coverage if the changes are implemented.

On August 22, 2025, the District Court in Maryland partially granted and partially denied the plaintiffs’ motion for a stay, pending a final ruling on the merits of the case.

• The provisions stayed include:
  • 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,
  • 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,
  • failure to reconcile APTC with PTC under filed tax return,
  • imposition of pre-enrollment eligibility verification requirements for all special enrollment periods,
  • requirement for Exchanges to verify household income inconsistencies when a tax filer’s attested projected annual household income differs from trusted data sources,
  • requirement that Exchanges verify a consumer’s annual household income when tax return data is unavailable, and
  • changes to the de minimis ranges for actuarial value calculations.
• The court declined to stay the effective dates of the following provisions:
  • change to the measure for calculating the premium adjustment percentage, and
  • elimination of the 60-day extension of time to resolve inconsistencies in household income data.

We expect CMS to issue guidance on its approach to necessary changes to filed plans and rates given the stay, in particular the changes to the de minimis ranges for AV calculations.