Author: Ciara F. Koba, Principal
CMS has released its latest Workers’ Compensation Medicare Set-Aside (WCMSA) Fiscal Year Statistics: 2022-2026, providing updated insight into WCMSA review activity, proposed allocation amounts, and Workers’ Compensation Review Contractor (WCRC) recommendations.
The FY2026 data shows an increase in completed WCRC recommendations compared with FY2025, while continuing to highlight differences between proposed WCMSA amounts and the amounts ultimately recommended through the review process.
FY2026 WCMSA Statistics at a Glance
CMS reported 15,596 WCRC recommendations completed in FY2026, up from 13,884 in FY2025. The total settlement amount associated with FY2026 reviews exceeded $2.35 billion, with an average settlement amount of $150,754.38.
Key FY2026 figures include:
- 15,596 WCRC recommendations completed
- $1.063 billion in total proposed WCMSA amounts
- $68,160.15 average proposed WCMSA
- $1.289 billion in total WCRC-recommended WCMSA amounts
- $82,681.25 average WCRC-recommended WCMSA
- 21% proposed vs. recommended change
The WCRC recommendations consisted of approximately $1.036 billion in recommended medical amounts and $253.6 million in recommended prescription drug amounts. On average, the recommended amounts were $66,422.87 for medical expenses and $16,258.57 for prescription drugs.
What the Latest Numbers Show
One of the most notable changes in the FY2026 data is the increase in review activity. WCRC completed 15,596 recommendations in FY2026 compared with 13,884 in FY2025, an increase of approximately 12% year over year.
At the same time, the average proposed WCMSA declined. The average proposed amount was $68,160.15 in FY2026, compared with $69,627.64 in FY2025 and $71,486.37 in FY2022.
The data also continues to show a difference between submitted proposals and WCRC recommendations. In FY2026, the average proposed WCMSA was $68,160.15, while the average WCRC-recommended amount was $82,681.25. CMS reports a 21% proposed-versus-recommended change for the year.
Looking at the components of the recommended amounts, the average recommended medical amount increased from $60,795.30 in FY2022 to $66,422.87 in FY2026, while the average recommended prescription drug amount decreased from $20,776.46 to $16,258.57 over the same period.
Why This Matters
CMS’s latest statistics provide an important benchmark for carriers, TPAs, employers, attorneys, and other stakeholders managing workers’ compensation settlements involving Medicare beneficiaries.
While these aggregate statistics cannot predict the outcome of an individual WCMSA review, the FY2026 data reinforces the importance of developing WCMSAs based on accurate medical records, treatment history, prescription information, and current CMS guidance.
The continued difference between proposed and WCRC-recommended amounts also underscores the importance of understanding the WCMSA review process and preparing well-supported submissions as part of the broader settlement strategy.
Takeaway
The FY2026 statistics show increased WCMSA review activity, with WCRC completing approximately 12% more recommendations than in FY2025. They also show that WCRC-recommended WCMSA amounts continued to exceed submitted proposed amounts on average.
For organizations managing workers’ compensation claims, the latest CMS data offers a useful opportunity to benchmark WCMSA practices and evaluate how Medicare considerations are being addressed throughout the settlement process.
Allan Koba Compliance Solutions helps organizations navigate WCMSA and Medicare Secondary Payer compliance, from WCMSA allocation development and submission support to broader settlement and compliance strategy.
Have questions about WCMSA or Medicare Secondary Payer compliance? Contact us at info@allankoba.com.
Source: CMS Workers’ Compensation Medicare Set-Aside (WCMSA) Fiscal Year Statistics 2026
