CMS will not drop lawfully present immigrants who lose premium tax credits in 2027. Guidance released October 5 re-enrolls them in their current plans at full price on January 1 and leaves their grace period to the issuer and state law, ending the three-month APTC grace period for them (CMS, October 5, 2026). The 2027 exit therefore runs through non-payment, where healthy members lapse first.
The eligibility change is statutory. Section 71301 of Public Law 119-21 limits APTC and income-based cost-sharing reductions, from plan year 2027, to citizens, nationals and three groups of eligible noncitizens: lawful permanent residents, Cuban and Haitian entrants, and Compact of Free Association migrants. Refugees, asylees, people with Temporary Protected Status and holders of work or student visas can still buy a marketplace plan, at gross premium. CBO put the cost of the provision at 900,000 more uninsured people by 2034 (CBO, August 25, 2025).
Key Takeaways
- January 1, 2027 is when federal-platform enrollees whose eligible status cannot be confirmed through DHS SAVE, and who do not update their application, lose APTC and CSRs and are generally re-enrolled without them.
- Three months of APTC grace period under 45 CFR 156.270(d) no longer apply to them; non-payment runs on the issuer's own grace policy under state law, and a binder is due where they are crosswalked to a new issuer.
- $67 to $594: Covered California's 141,530 affected enrollees pay a $67 average net premium on a $594 average gross premium, an 8.9-fold step-up when the credit goes.
- Nearly 90% of that group qualifies for cost-sharing reductions today, so January brings the loss of CSRs on top of a roughly ninefold premium increase.
- 95 days is the data-matching window in which an enrollee who attests to eligible status keeps APTC, pushing a second set of determinations into spring with uncapped repayment of any excess credit at tax time.
What the October 5 Guidance Does at Renewal
The guidance is an addendum to CMS's annual redetermination procedures for the federal platform, and it sorts every noncitizen enrollee who does not return during open enrollment into three branches. An enrollee whose eligible-noncitizen status the Exchange has already verified, or can newly verify through the Department of Homeland Security's SAVE system, keeps APTC and CSRs. An enrollee SAVE shows is no longer lawfully present loses marketplace coverage on January 1. Everyone else, including enrollees whose immigration status is valid but not an eligible one, is redetermined ineligible for financial assistance and re-enrolled without it (CMS, Q6 and Q9).
Three operating details change the arithmetic. First, the three-month grace period covers only enrollees receiving APTC when they fall behind, so these enrollees get the issuer's grace policy subject to state law, and anyone crosswalked to a different issuer must pay a binder or the policy is cancelled (Q10). Second, an enrollee who attests to an eligible status that SAVE cannot confirm keeps APTC and CSRs through a 95-day data-matching window (Q5). Third, a mixed-status household's credit excludes the premium for ineligible members (Q11).
The guidance covers the federal platform only; state-based exchanges run their own processes (Q12). Covered California has published the clearest profile of the people affected: 141,530 of 1,829,600 enrollees, or 7.7%, of whom 94% are subsidized today, including more than 45,000 with asylum or pending asylum status and nearly 10,000 with work or student visas (Covered California, June 17, 2026).
How Full-Price Renewal Sorts the 2027 Risk Pool
The price change is large enough to sort enrollees by expected claims. Covered California's affected enrollees pay a $67 average net premium against a $594 average gross premium, an 8.9-fold increase. Nearly 80% have incomes below 200% of the poverty level and nearly 90% qualify for cost-sharing reductions. In the most affected groups Covered California profiled, 82.5% are in silver, mostly the 87% and 94% variants, and 44% pay no premium at all. On the federal platform, re-enrollment without CSRs moves a silver CSR member to the plan's standard silver variant at full price: nine times the premium for higher cost sharing.
| Covered California, Feb. 2026 | Citizens | Eligible noncitizens | Lawfully present, ineligible in 2027 |
|---|---|---|---|
| Enrollees | 1,453,320 | 234,750 | 141,530 |
| Receiving subsidies | 80% | 91% | 94% |
| Income below 200% FPL (subsidized) | 49% | 58% | 78% |
| Enrolled through a certified agent (subsidized) | 55% | 68% | 87% |
A member who keeps paying $594 a month for 70% actuarial value coverage expects to use it. That is the selection UnitedHealthcare of Illinois priced into its 2027 filing, citing "a modest increase in expected claims costs" because the subsidy change would push some healthier members out (ACA Signups, June 11, 2026). A filing books that exit as a change in projected enrollment and average morbidity for the year. The guidance decides when it happens: members who neither return nor cancel are on the January roster at gross premium, and those who stop paying leave through the issuer's grace and termination process.
That timing moves claims into member months the filing may not have expected. Under the APTC rule an issuer pays the first grace month's claims and may pend the second and third (45 CFR 156.270). For these enrollees the period is whatever the issuer and state allow, which HealthCare.gov says may differ. The members who do pay are the ones whose claims justify $594. Kaiser, L.A. Care and Blue Shield of California hold 75.6% of the most affected groups Covered California profiled, so in that state the shift concentrates in a few issuers' experience and in the risk adjustment transfers they pay or receive.
The 95-Day Clock and the Household Re-Rate
January is the first exit, and the guidance builds in two more. An enrollee who attests to an eligible status that SAVE cannot confirm keeps APTC through the 95-day window, then loses it if the documents show a lawfully present but ineligible status (Q5). That places a second set of determinations in late winter and spring, 95 days after each application.
Section 71305 of the same law removed the cap on repaying excess APTC (CBO, August 2025), so an enrollee who rides the window and proves ineligible owes back the advance credit at tax time. Some will cancel in January rather than carry that liability, and they are unlikely to be the members with the largest claims ahead.
The third exit happens inside households. Because a mixed-status household's credit excludes the premium for ineligible members, citizen and green-card members stay subsidized while an ineligible member's share bills at gross. The household decides member by member, and the member it drops is the one who expects the fewest claims. Policy counts will understate that exit. Where a subscriber is removed for lack of lawful presence, the FFE assigns a new subscriber and re-rates the remaining members by age as of the new policy start date (Q9).
A 2027 rate built on one enrollment change now faces three: non-payment under issuer grace rules in January, data-matching determinations around April, and member-level drops that subscriber counts miss. Rates were filed in spring and summer; the guidance that decides how this exit unfolds arrived on October 5, weeks before open enrollment.
Further Reading
- A court reopens the 2027 ACA risk pool – the July injunction that restored enrollees insurers had priced their 2027 rates to exclude.
- How to read an ACA rate filing – where the morbidity adjustment and projected enrollment sit in the URRT and memorandum.
- KFF's 2027 median proposed increase of 15% – splitting trend from the subsidy-driven morbidity load.
- The ACA enrollment cliff – payer and non-payer morbidity in a contracting market, including the immigration provision as a scenario.
Sources
- CMS CCIIO: Guidance on Noncitizen Eligibility for APTC and CSRs for Plan Year 2027 (October 5, 2026)
- Congressional Budget Office: Clarifications of Marketplace Coverage and Eligibility Under Public Law 119-21 (August 25, 2025)
- Covered California: Lawfully Present Immigrants Eligibility Changes and Consumer Outreach, enroller webinar (June 17, 2026)
- ACA Signups: 2027 rate changes, Illinois (June 11, 2026)
- 45 CFR 156.270: Termination of coverage or enrollment for qualified individuals
- HealthCare.gov: Health insurance grace period