The Notice Nobody Wrote

On September 22, CMS cancelled roughly 315,000 Marketplace enrollments covering more than 760,000 people, and the agency published no consumer notification process and no appeals pathway in either the press release or the fact sheet it released the same day. Read both documents front to back. The dollar figure appears. The broker terminations appear. The people show up once, as a parenthetical. Somewhere right now a woman on a biologic sits six weeks away from calling her specialty pharmacy, hearing that her plan no longer exists, and having no idea who ended it or how to argue back.

CMS put the purpose in writing. The fact sheet, titled Federal Marketplace (FFE and SBE-FP) Anti-Fraud Actions and dated September 22, 2026, states that the action recovers approximately $2.2 billion in advance payments of the premium tax credit. The same document reports that CMS issued 569 notices of intent to terminate Exchange Agreements to agents and brokers. So the agency counted the money to the hundred million and the brokers to the single digit.

The timeline matters more than the September headline. That same fact sheet reports termination notices going out to more than 200 non-compliant agents and brokers since January 2026, so CMS worked this channel all year before the September action landed. All year, and no consumer notification workflow showed up alongside any of it. Open Enrollment opens six weeks from now, which hands every affected person one narrow door and no map to it.

Now set that against the denominator. CMS reported in its Health Insurance Exchanges 2026 Open Enrollment Report, using data through January 15, 2026, that 15.8 million consumers selected plans through HealthCare.gov, out of 23.1 million across all Exchanges. Put 760,000 next to 15.8 million and the share stops reading like a rounding error. These people carry diagnoses. Some of them started a specialty therapy this year. A few of them will reach a pharmacy counter in October and learn about federal program integrity from a technician who cannot help them.

Archo has fielded ELAVAY every year since 2015 across more than 20 disease states, asking patient advocacy organizations, professional societies, and community-based organizations how biopharmaceutical companies actually behave as partners. The pattern holds year over year. Companies grade their own advocacy performance well. The organizations they name as partners describe something different, and the gap between those two answers carries the whole finding.

Start with the structure, not the villains. CMS built the action around subsidy recovery and broker termination, so the agency measures the $2.2 billion and not the 760,000. The Federally-facilitated Marketplace pays agents and brokers per enrollment. That design rewards volume over accuracy, and 569 notices of intent to terminate tell you the channel produced exactly what the commission structure paid for. Nobody needs a conspiracy to explain that outcome. Read the incentive and you already have it.

Now the part my side owns. Patient advocacy organizations run on disease-specific foundation and corporate grants, and almost none of those grants carry a line item for Marketplace enrollment integrity. No advocacy group owned this population before the cancellations. None owns it now. Pharma patient services and HUB budgets fund copay support and prior authorization appeals for people who already hold a plan, so a patient losing Marketplace coverage falls out of the funded workflow entirely, quietly, before anyone opens a case. I have watched enough enforcement cycles arrive to know which column gets a budget line and which one gets a webinar.

The organizations that handle this well changed their behavior, not their mission statement. They track coverage loss as an operational metric next to adherence and time to therapy, and they staff a named person to reconcile disenrollment notices against their patient panel every month. They write the notification and appeals script before the enforcement action lands, then hand it to field teams and call centers while the phones still sit quiet. They fund navigator and enrollment assistance capacity on a calendar tied to the federal enforcement schedule, so the help exists in the weeks when people actually open the letter.

The median organization runs the same activities and produces none of the effect. It sponsors an access webinar in November, publishes a plan comparison one-pager, and never once reconciles a termination notice against its own panel. Same category of work. Completely different result, because somebody owns the number.

Three moves, each one small enough to assign by Friday. Assign one person to pull your patient services call logs for October and November, flag every contact that mentions a Marketplace termination letter, and report the count to your advocacy lead by December 15. Have your advocacy lead draft a one-page coverage termination response script covering what the letter means, the reconsideration window, and the Open Enrollment fallback, then route it to call center and field teams before November 1. Task your policy lead with submitting a comment or a direct inquiry to CMS asking for the consumer notification and appeals process attached to the 315,000 cancellations, and log whatever comes back in your policy tracker this quarter.

If you want to know whether your advocacy function sits close enough to the decision to matter, take the Advocacy Influence Diagnostic. Free, anonymous, five minutes, and it returns an Advocacy Visibility Index and a Strategic Risk Score. The 2025/2026 ELAVAY Report is available now, and fielding for 2026/2027 opens in October. Reach me directly at [email protected].