CMS Finalizes 2027 ACA Payment Parameters, Expands Hardship Exemptions and Bronze Plan Flexibility
CMS issued its final 2027 Notice of Benefit and Payment Parameters, adjusting risk adjustment methodology, setting user fee rates for Federally-facilitated Exchanges, and codifying expanded hardship exemption eligibility. The rule modifies QHP certification standards, prohibits routine non-pediatric dental services from counting as Essential Health Benefits, allows cost-sharing flexibility for catastrophic and bronze plans, and revises Basic Health Program payment calculations. Changes take effect for plan year 2027. While focused on the ACA individual and small group markets, the rule's risk adjustment and payment methodologies may inform Medicaid managed care rate-setting and actuarial approaches in integrated or dually eligible programs.
Risk adjustment and payment parameter changes in commercial markets often influence Medicaid rate-setting methodologies, particularly for integrated products serving dually eligible beneficiaries or in states operating Basic Health Programs that bridge Medicaid and Marketplace coverage.
Managed Care · Finance
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