“A bill to streamline enrollment in health insurance affordability programs and minimum essential coverage, and for other purposes.”
No CRS summary available for this bill.
This section defines 17 terms for purposes of the Act, including "CHIP program" (i.e., state child health plans under SSA title XXI), "Exchange" (i.e., ACA health insurance marketplaces), "insurance affordability program" (i.e., Medicaid, CHIP, ACA Exchanges with premium tax credits and cost-sharing reductions, state basic health programs, and other income-based coverage assistance programs), "net premium" (i.e., premium payments after premium tax credits, advance payments, and other insurance affordability program assistance, excluding ACA abortion funding segregation amounts), and "zero net premium" (i.e., $0 net premium).
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 elect (1) to identify any household member lacking minimum essential coverage, (2) to consent to disclosure of relevant tax return information to the applicable ACA Exchange (under new IRC §6103(l)(23)) for eligibility determinations and enrollment in insurance affordability programs (i.e., Medicaid, CHIP, or premium tax credits), and (3) to enroll such members in zero-net-premium minimum essential coverage if eligible, unless the member opts out or selects a different plan by the end of the specified special enrollment period. The election requires submission of 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 not on the tax return), but excluding citizenship, immigration status, or health status; the form must be accessible without discrimination and accompanied by clear information on insurance affordability programs. The Secretaries must also develop simple return language (e.g., referring to such programs as "free or low-cost health insurance"). (Thus, the program facilitates automatic enrollment and renewal in free coverage for uninsured individuals using tax data, subject to taxpayer consent and supplemental verification.)
This section directs Health Insurance Exchanges to use relevant tax return information, with taxpayer consent, to minimize additional data required for eligibility determinations for insurance affordability programs (i.e., advance payments of premium tax credits, reduced cost-sharing, Medicaid, and CHIP) by relying on return data, supplemental form information, and third-party sources (e.g., via Social Security number matching). It further requires Exchanges to (1) determine eligibility for CHIP and modified adjusted gross income-based Medicaid, subject to notice and appeal rights; (2) obtain any necessary additional information with minimal procedural burden (e.g., online collection during electronic filing, multiple contact attempts before denial) and full procedural protections, including the reasonable opportunity period under SSA §1137(d); and (3) for individuals eligible for non-Medicaid/CHIP programs, enable applications to those programs with notice of procedures. This section also requires the Secretary of HHS, in states where HHS operates eligibility determinations, to offer states at least three customizable sets of verification procedures and business rules (e.g., for data use, administrative renewals) for Medicaid and CHIP eligibility; directs a default option if a state does not select; and requires Exchanges finding eligibility to transmit data for state enrollment in Medicaid or CHIP (with consent for zero-premium coverage), subject to exceptions.
This section requires states, effective January 1, 2027, to rely on eligibility findings from the Temporary Assistance for Needy Families (TANF) program or Supplemental Nutrition Assistance Program (SNAP) for determining financial eligibility, citizenship or satisfactory immigration status, and state residence under Medicaid state plans or waivers—for initial eligibility and redeterminations—with such reliance on SNAP findings mandatory only for individuals under 19 years of age or those covered under the Medicaid expansion population (i.e., adults up to 138% of the federal poverty level) and optional for others. The section further requires states to deem individuals financially eligible for Medicaid using modified adjusted gross income (MAGI)—the standard post-ACA methodology for most non-elderly, non-disabled enrollees—if their eligibility date falls in January through April and their preceding calendar year's MAGI meets applicable thresholds, while preserving other income verification methods (e.g., current tax data or projected annual income) and eligibility for greater benefits or lower cost-sharing. This section also amends the premium tax credit under IRC §36B to replace references to the "taxable year" with the "applicable tax year" in household income calculations for advance payments and reconciliation, including for applicable taxable years beginning after 2027.
This section enhances data access and sharing for insurance affordability programs (i.e., ACA Exchanges, Medicaid, CHIP, basic health programs, premium tax credits, and cost-sharing reductions) to verify eligibility, income, and employer-sponsored coverage. Specifically, the section (1) amends SSA §453(i) to require the Secretary to provide such programs access to National Directory of New Hires data on identity, employer, quarterly wages, unemployment compensation, and new hires, with reimbursement of costs; (2) permits Exchanges to use such data for advance premium tax credit, cost-sharing reduction, and basic health program eligibility, and permits Medicaid and CHIP to use it for eligibility and third-party liability or premium assistance, subject to notice and appeal rights; (3) authorizes access to group health plan coverage data from HHS Medicare secondary payer records (42 U.S.C. 1395y(b)), state Medicaid third-party liability records, and IRS reporting under IRC §§6055 and 6056, subject to privacy-protecting agreements; (4) authorizes federal, state, or private entities to share relevant eligibility data with such programs under Medicaid-equivalent protections and penalties; and (5) requires electronic transmission of data from Express Lane Agencies or other public sources and waives certain applicant verification requirements for such data.
This section appropriates to the Secretary of Health and Human Services such sums as necessary for information technology development and operations to support information exchange and processing infrastructure and procedures required by this Act. The Secretary may transfer funds 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, and basic health programs under ACA §1331 (42 U.S.C. 18051); (4) entities operating an Exchange; and (5) third-party data sources (public or private), subject to transfer request, review, approval, appeal, and audit procedures established by the Secretary in consultation with the Secretary of the Treasury.
This section amends state income and eligibility verification requirements under Section 1137 of the SSA. (1) It deems individuals who consent to SSN disclosure and transfer under the Easy Enrollment in Health Care Act to have satisfied the SSN furnishing requirement. (2) It conditions the citizenship declaration requirement on new subsection (d)(6), which exempts applicants for Medicaid or CHIP if citizenship was verified via data matches using procedures from the Easy Enrollment Act or ACA Section 1413(c)(2)(B)(ii)(II) based on SSN and other identifying information (e.g., name, date of birth). (Thus, states may rely on automated matches with citizenship data sources rather than applicant declarations.) This section also amends ACA Section 1411(b) eligibility determinations by revising the income and family size information requirement to specify data from IRC Sections 6103(l)(21) and (23) and by adding paragraph (6) to permit satisfying information requirements through reliable data matches (subject to SSA Section 1137(d)(6) for certain cases). (As background, Section 1137 requires states to verify citizenship, SSN, income, and other data for means-tested programs including Medicaid, CHIP, TANF, and SNAP.)
This section establishes an advisory committee under the Secretaries of the Treasury and Health and Human Services to provide guidance to both Secretaries in carrying out this Act. The committee includes (1) national experts in behavioral economics and science, insurance affordability programs, health and benefit program enrollment and retention, public benefits for immigrants and historically marginalized 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 requiring consultation between the two Secretaries under this Act.
This section directs the Secretary of Health and Human Services to conduct a study analyzing the impact of this Act and making recommendations for (1) state pilot projects to test improvements to this 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 this Act. The Secretary must submit a report on the study 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 this Act, in addition to amounts described in section 7 and any amounts otherwise made available, with funds remaining available until expended.