CMS Releases New WCMSA Reference Guide (Version 4.6)

By Kate Riordan, J.D., Kristen Carlson, J.D.

July 20, 2026 / 4 min read

The Centers for Medicare and Medicaid Services (CMS) has released WCMSA Reference Guide (Version 4.6, July 13, 2026).

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As part of the Version 4.6 updates, CMS notes that it has updated the language contained in its “sample” WCMSA Approval Letter (Appendix 5, p. 79) and Notice of Settlement Received Letter (Appendix 5, p. 94).^[1]The updates made by CMS to these sample letters focus on situations involving WCMSAs funded by an annuity and scenarios involving WCMSAs where the claimant is a Medicare Part C (Medicare Advantage) and/or Medicare Part D (RX) beneficiary, outlined, in general, as follows:

Sample WCMSA Approval Letter

First, CMS has added language to the sample WCMSA Approval Letter contained in Appendix 5 noting that WCMSA amounts not used in a given year as part of a WCMSA funded via annuity must remain in the WCMSA account to pay for related medical care during the following years. Further, CMS has also added language to this sample letter noting that if available WCMSA funds for a particular year (including the current year’s full structured payment plus any prior year’s remaining funds plus interest) have been properly spent, then Medicare will pay for covered items and services that are related to the workers’ compensation claim for the remainder of that year until the scheduled date for the next year's deposit into the WCMSA account.

While CMS has now added the above language to its “sample” WCMSA Approval Letter as contained in Appendix 5, it is noted that CMS has been including this language in the actual WCMSA Approval Letters it has been sending out to the parties for quite some time. As such, CMS’s new updates to the sample WCMSA Approval Letter, as contained in Appendix 5, now align with the actual approval letters CMS has been sending out to the parties.

Second, CMS has also added updated language regarding Part C/D plans to the sample WCMSA Approval Letter contained in Appendix 5. In this regard, this language notes that CMS will alert the Medicare Advantage plan (Part C) or prescription drug plan (Part D) to the existence of an approved WCMSA, but that it will not provide these plans with information relative to specific treatments or medications that should be covered by the WCMSA. Further, CMS’s language alerts the beneficiary that their Medicare Advantage or prescription drug plan may contact them for details and that if the request goes unanswered, coverage may be delayed or cancelled.

On these points, CMS’s language reads as follows: “CMS does not provide these plans with specific information about your specific treatments and medications that should be covered by your WCMSA. Your plan may contact you or your administrator to find out which expenses are covered by your WCMSA. If you do not respond to your Medicare Advantage or prescription drug plan’s investigation efforts, your coverage may be delayed or cancelled.”^[2] In the big picture, these new updates are similar to those initially noted by CMS in its WCMSA Reference Guide and Self-Administration Tool-Kit updates back in August 2024.^[3]

Third, CMS has added language to the sample WCMSA Approval Letter reflecting a new fax number to be used regarding the submission of settlement documents that are 10 pages or less, and has added language to reflect how the MSA was calculated in regard to the workers’ compensation fee schedule of the applicable jurisdiction.

Notice of Settlement Received Letter

To the sample Notice of Settlement Received Letter as contained in Appendix 5, which is a separate letter from the WCMSA Approval Letter, CMS has added similar language regarding Part C and Part D plans as updated in the sample WCMSA Approval Letter outlined above. On this point, as one example, CMS has added language to the Notice of Settlement Received Letter indicating that the claimant’s Part C or Part D plan may contact the claimant, or their WCMSA administrator, to find out which expenses are covered by your WCMSA and that if he or she does not respond to their Medicare Advantage or prescription drug plan’s investigation efforts, coverage may be delayed or cancelled.

Questions?

Please do not hesitate to contact the authors if you have any questions about this update or its potential impact regarding WCMSAs.

[1] WCMSA Reference Guide (Version 4.6, July 13, 2026), Chapter 1.1 (“Changes in This Version of the Guide).

[2] WCMSA Reference Guide (Version 4.6, July 13, 2026), Appendix 5, WCMSA Approval Letter.

[3] See, CMS’s WCMSA Reference Guide (Version 4.1, August 1, 2024) and WCMSA Self-Administration Tool-Kit (Version 1.6, August 1, 2024).