H.R. 3947 — Easy Enrollment in Health Care Act

This section establishes definitions for purposes of the Act for 17 terms, including CHIP program (i.e., a state child health assistance plan under SSA title XXI), Exchange (i.e., an ACA health insurance exchange), insurance affordability program (i.e., Medicaid, CHIP, ACA Exchanges with premium tax credits and cost-sharing reductions, state basic health programs, and certain other income-based coverage assistance programs), net premium (i.e., premium payments after subsidies, excluding certain abortion-related segregation amounts), and zero net premium (i.e., a net premium of $0.00).

This section directs the Secretary of the Treasury, not later than January 1, 2028 and in consultation with the Secretary of Health and Human Services, to establish a program allowing taxpayers filing returns for taxable years beginning after December 31, 2026 to identify uncovered household members (i.e., lacking minimum essential coverage) and elect (1) consent to disclosure of relevant return information to an applicable Exchange for eligibility determinations for insurance affordability programs (i.e., Medicaid, CHIP, basic health programs, or premium tax credit-eligible plans) and (2) enrollment of such members in zero-net-premium minimum essential coverage unless they opt out or select a different plan by the end of a special enrollment period. Taxpayers providing consent must also submit a supplemental form collecting additional eligibility information (e.g., state of residence, date of birth, employment status, changed circumstances, contact preferences, and household composition details) but excluding citizenship, immigration status, or health status; the form must be accessible without discrimination and accompanied by simplified language describing such programs as "free or low-cost health insurance." (Thus, the program enables streamlined, tax-time enrollment and potential automatic renewals using IRS data, subject to taxpayer elections and supplemental verification.)

This section directs an Exchange receiving relevant tax return information under section 3(d) with taxpayer consent to (1) minimize additional information required for household members to qualify for insurance affordability programs (i.e., premium tax credits, cost-sharing reductions, Medicaid, CHIP) by using such return data—including supplemental form information—and other third-party sources obtained via data matching; (2) determine eligibility for CHIP and modified adjusted gross income-based Medicaid, subject to notice and appeal rights; (3) obtain any necessary additional information with the lowest procedural burden (e.g., online collection for electronic filers, multiple contact attempts) and full protections, including the reasonable opportunity period under SSA section 1137(d)(4)(A); and (4) for individuals eligible for a program other than Medicaid, enable them to seek Medicaid or CHIP by providing additional information, with notice of procedures and subject to appeal rights. This section requires HHS, for states where it determines eligibility at the Exchange, to provide each state at least three customizable sets of verification procedures and business rules (covering data use, initial applications, renewals, and administrative renewal based on probable continued eligibility) for Medicaid and CHIP; directs use of a default option if a state does not select within HHS's timeframe; and requires the Exchange to transmit eligibility information to the state for prompt enrollment in Medicaid or CHIP if applicable (with consent for zero-premium coverage), subject to exceptions.

This section amends Medicaid eligibility verification rules (under SSA §1902(e)(14)) to (1) require states to rely on findings of eligibility for the Supplemental Nutrition Assistance Program (SNAP) or Temporary Assistance for Needy Families (TANF) for an individual's financial eligibility, citizenship/immigration status, and state residency both initially and at redetermination (limited, for SNAP, to individuals under 19 years of age or qualifying under Medicaid expansion authority at SSA §1902(a)(10)(A)(i)(VIII), with state option to expand), and (2) permit use of an individual's modified adjusted gross income (MAGI) from the preceding calendar year to establish financial eligibility if the eligibility date falls in January through April. (Thus, for new applicants or redeterminations, this reduces duplicative verifications and stabilizes eligibility during early-year application surges using prior-year tax data.) It makes a conforming amendment and applies these changes effective January 1, 2027. The section further amends the premium tax credit under IRC §36B(b) to replace multiple references to "taxable year" with "applicable tax year" (including insertions specifying applicability after 2027) to promote coverage stability.

This section authorizes insurance affordability programs (i.e., ACA Exchanges providing advance premium tax credits under ACA §1412, cost-sharing reductions under ACA §1402, basic health programs under ACA §1331, Medicaid, and CHIP) to access specified data for eligibility determinations, third-party liability, and premium assistance. Specifically, it (1) amends SSA §453(i) (42 U.S.C. 653(i)) to grant such programs access to the National Directory of New Hires for identity, employer, quarterly wages, unemployment compensation, and new hire information, subject to reimbursement of HHS costs; (2) permits Exchanges, Medicaid, and CHIP to use such data to assess eligibility, minimum essential coverage offers via group health plans, and related procedures, with notice and appeal rights; (3) requires public entities to share group health coverage data (e.g., from Medicare secondary payer implementation under SSA §1862(b) (42 U.S.C. 1395y(b)), state Medicaid third-party liability under SSA §1902(a)(25) or (60), and IRS reporting under IRC §§6055/6056) via data-sharing agreements ensuring privacy and security; (4) authorizes federal, state, or private entities to convey relevant eligibility data to such programs, subject to Medicaid data protections and penalties under SSA §1942; and (5) directs electronic transmission of data from Express Lane Agencies, other public agencies, or reliable sources, waiving redundant applicant verification for such elements.

This section appropriates to the Secretary of Health and Human Services (HHS) such sums as may be necessary, from amounts in the Treasury not otherwise appropriated, to establish information exchange and processing infrastructure and operate related procedures under this Act, including costs for staff and contractors. HHS may transfer such funds, as necessary and per specified procedures, to (1) the Secretary of the Treasury (including the Internal Revenue Service); (2) HHS's Office of Child Support Enforcement; (3) state-administered insurance affordability programs, including Medicaid, CHIP, or a state basic health program (i.e., an ACA program under which states contract for standard health plans offering essential health benefits to eligible individuals in lieu of Exchange coverage); (4) entities operating an Exchange; or (5) third-party data sources. HHS, in consultation with the Secretary of the Treasury, must establish procedures for such entities to request, review, modify, approve, appeal, and audit fund transfers.

This section amends Section 1137 of the Social Security Act (42 U.S.C. 1320b-7), which requires states to verify income, eligibility, and citizenship status for applicants to certain federal programs (i.e., Medicaid, CHIP, TANF, and others). Specifically, it (1) deems an individual who consents to disclosure of return information including their social security number (SSN) under section 3(b)(1)(B) of the Easy Enrollment in Health Care Act to have satisfied the SSN furnishing requirement; (2) subjects the state's requirement for an applicant declaration of citizenship or immigration status to a new exception in paragraph (d)(6); and (3) adds paragraph (d)(6) to exempt such declaration for Medicaid or CHIP applicants if citizenship was verified using procedures under section 3(a)(1) of the Easy Enrollment in Health Care Act or ACA §1413(c)(2)(B)(ii)(II) based on SSN and other identifying information (e.g., name, date of birth). This section also amends ACA §1411(b) (42 U.S.C. 18081(b)), which governs eligibility determinations for health insurance Exchanges, to (1) specify that income and family size information is that described in IRC §6103(l)(21) and (23) for the applicable taxable year; and (2) add paragraph (6) permitting data matches—meeting SSA §1137(d)(6) requirements where applicable—to satisfy information submission requirements in lieu of applicant-provided data.

This section establishes an advisory committee, with the Secretary of the Treasury in conjunction with the Secretary of Health and Human Services, to provide guidance to both Secretaries in carrying out this Act. The committee includes (1) national experts in behavioral economics, other behavioral science, insurance affordability programs, enrollment and retention in health programs and other benefit programs, public benefits for immigrants, public benefits for other historically marginalized or disadvantaged communities, and Federal income tax policy and operations; and (2) representatives of consumers, health insurance issuers, health care providers, and tax return preparers. The committee provides advice on topics selected by either Secretary, including at a minimum all matters under this Act (other than this section) requiring consultation between the two Secretaries.

This section directs the Secretary of Health and Human Services to conduct a study analyzing the impact of the Act and making recommendations on (1) state pilot projects to test improvements to the Act, including policies for automatic enrollment of eligible individuals into group health plans; (2) modifying open enrollment periods for Exchanges and plan years to coincide with federal income tax return filing; and (3) other steps to improve outcomes achieved by the Act. The Secretary must submit a report on the study and recommendations to the House Committees on Ways and Means, Education and the Workforce, and Energy and Commerce, and the Senate Committees on Finance and Health, Education, Labor, and Pensions, by July 1, 2030.

This section appropriates such sums as may be necessary to the Secretary of the Treasury and the Secretary of Health and Human Services to carry out the purposes of the Act, in addition to amounts described in section 7 and otherwise available, with funds remaining available until expended.