The Ministry of Health has proposed amendments to Federal Law No. 326-FZ "On Compulsory Medical Insurance"

According to the explanatory note, the initiative was developed in anticipation of the preparation of the draft law on the budget of the Federal Compulsory Medical Insurance Fund for 2026 and for the planning period of 2027 and 2028.

TFOMS will be allowed to act as medical insurance organizations

According to the thematic document, regional heads will now be able to decide on the implementation of the territorial fund (TFOMS)'s authority over medical insurance organizations in their respective territories for a period of no less than three years.

Their responsibilities will include registration, renewal, and issuance of policies, maintaining records of insured persons, paying for medical care at clinics, collecting and processing personalized records, and providing information on the types, quality, and conditions of medical care.

This innovation is necessary for the territorial compulsory medical insurance funds (TFOMS) to formally fulfill their functions in the four new regions—the DPR, LPR, and the Zaporizhia and Kherson oblasts. It was announced back in 2022 that medical insurance companies would be barred from operating in these territories, with all insurance powers being confined to the territorial funds.

The Federal Law will detail the organization of compulsory medical insurance in new regions.

Starting in 2024, medical care in the new regions will be financed partly from the federal budget and partly through direct interbudget transfers from the Federal Compulsory Medical Insurance Fund (FFOMS). In 2024, the compulsory medical insurance budget for these regions amounted to 39 billion rubles, and in 2025, it increased to 58.1 billion rubles. The Ministry of Health proposed clarifying in the Federal Law that only certain medical organizations from a list determined by the Russian Government jointly with the Ministry will receive compulsory medical insurance funds from this source.

The amendments introduce some technical details for medical care payments in 2026. Specifically, the differentiation coefficient for determining the 2026 insurance premium rate for the compulsory medical insurance (CMI) for the unemployed population for the new regions will be as follows: 0.3340 for the DPR and LPR, and 0.3333 for the Zaporizhzhia and Kherson oblasts. The number of insured individuals will be determined by the Federal Compulsory Medical Insurance Fund (FFOMS) jointly with the Territorial Compulsory Medical Insurance Fund (TFOMS) based on personalized records. According to the latest data, the combined total for the four regions is 3.2 million people.

It will become more difficult for foreigners to obtain compulsory medical insurance (CMI) policies.

The Ministry of Health proposed, among other things, increasing the minimum insurance period (the number of years during which the employer pays contributions) for certain categories of foreign citizens to obtain compulsory medical insurance (CMI) from three to five years. These professionals and their families were granted full CMI coverage in 2023. Theoretically, the first foreigners in this cohort could receive CMI policies as early as 2026; however, if the current proposal is approved, the deadline will be pushed back to 2028.

FFOMS employees receive housing subsidies

The law may be supplemented with a provision allowing FFOMS employees to receive a one-time housing subsidy. The Russian Government will establish the terms and conditions. Social guarantees will be financed from the FFOMS budget, which is earmarked for the financial and logistical support of the fund's ongoing operations. By the end of 2024, this budget item amounted to 1.9 billion rubles.

The conditions for the targeted use of compulsory medical insurance funds are being clarified

According to general rules, all medical organizations operating under the compulsory medical insurance system are permitted to spend funds on what are typically considered non-targeted expenses at the end of the financial year and provided all conditions of the compulsory medical insurance agreement are met. The draft presented by the Ministry of Health proposes formally separating regional, private clinics, and federal medical organizations. However, the terms and conditions for spending funds remain unchanged from the current version of the law.