Upcoming Changes to Workers’ Compensation Medicare Set-Aside (WCMSA) Process

Centers for Medicare & Medicaid Services

Based on review of current WCMSA guidance and feedback from the WCMSA community, CMS will be implementing the following changes in the first half of 2025.

Amended Reviews: Currently, amended review requests cannot be submitted until 1 year after a WCMSA case has been approved. Effective April 7, 2025, amended review requests will be allowed at any time after a WCMSA case is approved.

Zero-Dollar Set-Asides: Effective July 17, 2025, CMS will no longer accept or review WCMSA proposals with a zero-dollar ($0) allocation. Entities should still consider the parameters available in the WCMSA Reference Guide (PDF) to determine whether a zero-dollar WCMSA allocation is appropriate and should maintain documentation to support that allocation.

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