CMS Keeps the 35% Essential Community Provider Standard in the 2027 Marketplace Final Rule — a Rulemaking Win NACHC Fought For

In the 2027 Notice of Benefit and Payment Parameters final rule (published May 15, 2026; effective July 20), HHS declined to finalize its proposal to cut the Essential Community Provider contracting standard from 35% to 20% — qualified health plans must still contract with at least 35% of available ECPs, a category that includes FQHCs, in each service area.

NACHC had formally opposed the cut in comments, calling it 'premature' absent any assessment of how the 35% threshold affects access for the low-income patients health centers serve, and claimed the outcome as a rulemaking win in a July 8 post. The final rule also prohibits issuers from including routine non-pediatric (adult) dental services as an essential health benefit and tightens enforcement when premium-tax-credit recipients fail to file and reconcile.

For health centers, the standing 35% floor preserves in-network eligibility with Marketplace plans and the commercially insured volume that supports their payer mix.