May 21, 2026

The final rule permits individuals to enroll in catastrophic plans with terms of up to 10 years and expands eligibility for consumers who do not qualify for ACA subsidies but experience changes in household income. CMS maintains that catastrophic coverage provides a more affordable alternative for consumers priced out of traditional exchange plans. The rule also allows insurers to offer exchange plans without provider networks for the first time, marking a significant shift in marketplace plan design.

The restructuring creates separate divisions within the Office for Civil Rights, with one dedicated to civil rights enforcement and another focused on health information privacy, cybersecurity, and data protection. The announcement comes as HHS continues navigating a broader departmental restructuring that has resulted in approximately 15,000 layoffs since the end of the Biden administration.

Senate Democrats introduced a resolution to overturn CMS’ WISeR pilot program, which uses AI-backed prior authorization in traditional Medicare for certain high-cost or fraud-prone services. They argue the model delays care for seniors, while CMS says it’s intended to reduce fraud, inappropriate care, and unnecessary spending. The effort follows a recent Government Accountability Office ruling that the pilot qualifies as agency rulemaking and can therefore be challenged under the Congressional Review Act.

The Centers for Medicare and Medicaid Services (CMS) proposed a rule that would cap certain Medicaid state-directed payments closer to Medicare reimbursement levels, aiming to reduce what the agency says are inflated costs and opaque financing arrangements in the program. The rule could save an estimated $775 billion over 10 years and is part of the Trump administration’s broader push to address fraud, waste, and abuse in Medicaid.

The average deductible for an Affordable Care Act plan has reached record highs after jumping more than $1,000 between 2025 and 2026. This has resulted in estimates that the marketplace enrollment could fall by 5 million people, or 21.5%, as Americans fail to pay their premiums.