On November 9, 2026, the Centers for Medicare & Medicaid Services (CMS) released its “Workers’ Compensation Medicare Set-Aside (WCMSA) Fiscal Year Statistics: 2022–2026.”
The report provides updated information about WCMSA proposals voluntarily submitted to CMS and the recommended amounts following review by the Workers’ Compensation Review Contractor (WCRC).
By the Numbers
The one-page report is divided into two tables.
The first table covers proposed WCMSA values related to submissions voluntarily sent to the WCRC. The WCRC is the CMS contractor responsible for reviewing these proposals and rendering decisions.
Table 1 includes fiscal-year statistics for:
- Total WCRC Recommendations Completed: The number of proposals for which the WCRC rendered a decision
- Total Settlement Amount: The aggregate settlement amounts associated with submitted WCMSAs
- Total Settlement Amount Average: The average settlement amount associated with a WCMSA
- Total Proposed WCMSA Amount: The aggregate amount proposed by submitters, rather than the amount recommended or approved by CMS
- Total Proposed WCMSA Average: The average proposed WCMSA amount, rather than the final amount approved by CMS
The second table covers the amounts determined by the WCRC following its review of voluntarily submitted proposals. In other words, this table shows what CMS indicates the WCMSA should be compared with the amount initially proposed by the submitter.
Table 2 includes fiscal-year statistics for:
- Total WCRC Recommended WCMSA Amount: The aggregate WCMSA amounts recommended by the WCRC
- Total WCRC Recommended WCMSA Average: The average WCMSA amount recommended by the WCRC
- Percentage Proposed vs. Recommended Change: The percentage difference between the amount proposed by the submitter and the amount determined by the WCRC
- Recommended Medical Amount: The aggregate amount determined by the WCRC for the healthcare services portion of WCMSAs
- Recommended Medical Amount Average: The average amount determined for the healthcare services portion of an individual WCMSA
- Recommended Rx Amount: The aggregate amount determined by the WCRC for the prescription drug portion of WCMSAs
- Recommended Rx Amount Average: The average amount determined for the prescription drug portion of an individual WCMSA
Highlights
WCMSA Decisions Increased from FY 2025 to FY 2026
In FY 2026, the WCRC completed 15,596 recommendations, a 12.3% increase over the 13,884 recommendations completed in FY 2025.
It is important to note that these figures represent WCMSA proposals for which the WCRC rendered a decision. They do not account for every proposal submitted to the WCRC, a figure CMS does not publicly report.
The FY 2026 total was only 147 decisions below the five-year high of 15,743 recorded in FY 2023.
The rebound is notable given CMS’s July 2025 policy change under which the WCRC stopped accepting zero-dollar WCMSA submissions. Eliminating zero-dollar submissions may have been expected to reduce the number of cases entering the review process.
However, it is unknown how many zero-dollar submissions were previously included in the overall population of WCMSA proposals. Several factors could have contributed to the increase in completed recommendations.
Heightened CMS scrutiny, changes to Section 111 reporting requirements, and the implementation of Civil Monetary Penalties may have encouraged more parties to submit WCMSA proposals.
The WCRC may have also cleared a backlog of cases submitted during an earlier period. Changes in WCRC staffing, processes, or productivity may have contributed to the increase in completed recommendations.
Additionally, CMS updated its Amended Review policy effective April 7, 2025. Under the updated policy, submitters may use the Amended Review process at any time after a decision is rendered rather than waiting one year.
There may also have simply been more voluntary submissions. CMS’s published data does not confirm the reason for the increase.
Proposed WCMSA Amounts
Proposed WCMSA amounts remained relatively consistent from FY 2022 through FY 2026, averaging $70,187.41 over the five-year period. The average proposed WCMSA amount in FY 2026 was $68,160.15, a 2.1% decrease from the FY 2025 average of $69,627.64. The average proposed amount has steadily decreased over the five-year period. The FY 2026 average was 4.65% lower than the five-year high of $71,486.37, recorded in FY 2022. Total proposed WCMSA amounts reached approximately $1.06 billion in FY 2026, up from approximately $966.7 million in FY 2025.
Recommended WCMSA Amounts
Recommended WCMSA amounts averaged $84,560.33 over the five-year period. The average recommended amount in FY 2026 was $82,681.25, a 4.05% decrease from the FY 2025 average of $86,168.57.
Although the average recommended amount decreased, the total recommended WCMSA amount increased. Total recommended amounts reached approximately $1.29 billion in FY 2026, up 7.8% from approximately $1.20 billion in FY 2025. The combined recommended WCMSA amounts from FY 2022 through FY 2026 totaled approximately $6.25 billion.
Counter-Highers
When the WCRC reviews a WCMSA submission and recommends an amount higher than the amount initially proposed, the determination is often referred to as a “counter-higher.” See Section 9.4.4 of the WCMSA Reference Guide, Version 4.7.
In FY 2026, the average proposed WCMSA amount was $68,160.15, while the average recommended amount was $82,681.25, a difference of $14,521.10 per case.
The percentage difference between proposed and recommended amounts decreased slightly, from 24% in FY 2025 to 21% in FY 2026.
Looking across the full five-year period, total proposed WCMSA amounts reached approximately $5.18 billion, compared with approximately $6.24 billion in total recommended amounts. Based on these rounded totals, the cumulative difference between proposed and recommended amounts from FY 2022 through FY 2026 was approximately $1.06 billion.
Looking further back at CMS’s published data, the percentage difference was 13% in FY 2020, 15% in FY 2021, and 14% in FY 2022. Since FY 2023, the difference has averaged 22%.
Average Medical and Prescription Drug Amounts
CMS’s published report does not provide a breakdown of the proposed medical and prescription drug amounts. It does, however, provide this information for the amounts recommended by the WCRC.
The average recommended medical amount decreased slightly from $68,667.79 in FY 2025 to $66,422.87 in FY 2026, a decline of approximately 3.3%. At the same time, the total recommended medical amount increased by approximately 8.65%, from $953.4 million in FY 2025 to approximately $1.04 billion in FY 2026. The average recommended prescription drug amount has trended downward over the past five years. It decreased from $17,500.78 in FY 2025 to $16,258.57 in FY 2026, a decline of approximately 7.1%. The FY 2026 average was the lowest prescription drug amount reported during the five-year period.
WCMSA Amounts in Proportion to Settlement Amounts
The average settlement amount from FY 2022 through FY 2026 was approximately $159,128.
In FY 2026, the average settlement amount was $150,754.38, a 6.5% decrease from the FY 2025 average of $161,251.19. The average recommended WCMSA amount of $82,681.25 represented approximately 55% of the average FY 2026 settlement amount. For comparison, the average recommended WCMSA amount represented approximately 53% of the average settlement amount in FY 2025. This reflects an increase of about 1.4 percentage points from one year to the next.
Closing Thoughts
The workers’ compensation industry appreciates CMS providing data about the Medicare Secondary Payer program, particularly as the data relates to WCMSAs. This information helps stakeholders make informed decisions, monitor trends, and evaluate their compliance programs.
Ametros closely follows these developments to inform best practices for the professional administration of WCMSAs and identify where parties to a settlement may need additional support. Setting aside the appropriate amount of money is an important step, but funding a WCMSA is only the beginning. The account must also be properly administered after settlement. Funds need to be used for allowable injury-related expenses, accurate records must be maintained, and applicable reporting requirements must be met.
Ametros supports injured individuals and settlement stakeholders by managing the ongoing responsibilities associated with a WCMSA. Through professional administration, Ametros helps pay medical bills, maintain records, track expenses, and simplify the post-settlement experience. This support helps injured individuals focus more of their time and energy on their health and life after settlement.
