A Maryland judge's decision to toss several provisions of a 2025 regulation on Affordable Care Act (ACA) marketplaces, several of which overlap with more recent rulemaking, has been appealed by the Department of Health and Human Services.
According to court documents, HHS filed its appeal last week and a case was opened in the U.S. Court of Appeals for the 4th Circuit on Tuesday. Maryland District Judge Brendon Hurson had ruled in favor of plaintiffs—several cities and patient advocacy groups—last month.
The disputed rule largely applied to the 2026 plan year and involved provisions the plaintiffs said would reduce access to coverage and incur more costs. Among these were a $5 penalty for automatic re-enrollments, and for the 2027 plan year a shortened enrollment period.
The relevant provisions were stayed last August, days before they were set to go into effect, with the case playing out over the months since. HHS, throughout, said its attempted regulations would clamp down on fraud and help address health insurance costs.
The development also comes shortly after the same judge, Maryland District Judge Brendon Hurson made a ruling in a separate case with many of the same plaintiffs. It temporarily stopped similar provisions in rulemaking finalized in May from going into effect in regard to the upcoming 2027 plan year.
June 15
Judge tosses multiple provisions of CMS' 2025 ACA program integrity rule
A federal judge has vacated several key components of a controversial 2025 program integrity rule for the Affordable Care Act's marketplaces.
In an order issued Friday, Maryland District Judge Brendon Hurson tossed multiple elements of the regulation, including a $5 penalty for automatic re-enrollments and an element that would revoke guaranteed coverage for people who have past-due premiums.
In addition, the court vacated a shortened enrollment period for the 2027 plan year, new eligibility verifications for special enrollment periods and plans to eliminate a 60-day extension that would allow individuals to address inconsistencies in household income, per the court filing.
Hurson had issued a stay on multiple provisions of the rule late last year following the legal challenge from multiple U.S. cities and patient advocacy groups.
"The agency cannot utilize its general rulemaking authority to override·explicit statutory provisions," Hurson wrote.
While he did vacate multiple central elements of the 2025 rule, Hurson allowed to stand changes to the methodology that the Centers for Medicare & Medicaid Services (CMS) uses to calculate premium adjustments, saying that the rule did successfully support the argument for those updates.
Regulators at CMS said that the rule is intended to address what they argue is rampant fraud on the exchanges, particularly the federal exchange, Healthcare.gov. Research from the right-leaning think tank Paragon Health Institute estimates that 5 million individuals may have been improperly enrolled in ACA plans in 2025 alone.
The program integrity changes alongside the expiration of enhanced premium tax credits for exchange enrollees have had major impacts on insurers operating in this market.
Similar changes finalized in a regulation last month have also drawn ire, with a group of cities suing last week to block the rule.
The regulation for the 2027 plan year aims to roll back limits on non-standard plans and expand access to catastrophic and non-network plans as a solution to help mitigate rising premiums.