I 

118TH CONGRESS 

1ST SESSION H. R. 1113 

To streamline enrollment in health insurance affordability programs and 

minimum essential coverage, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 21, 2023 

Mr. BERA introduced the following bill; which was referred to the Committee 

on Energy and Commerce, and in addition to the Committee on Ways 

and Means, for a period to be subsequently determined by the Speaker, 

in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To streamline enrollment in health insurance affordability 

programs and minimum essential coverage, and for other 

purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Easy Enrollment in 

5 Health Care Act’’. 

6 SEC. 2. DEFINITIONS. 

7 In this Act: 


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1 (1) CHIP PROGRAM.—The term ‘‘CHIP pro2 gram’’ means a State plan for child health assist3 ance under title XXI of the Social Security Act (42 

4 U.S.C. 1397aa et seq.), including any waiver of such 

5 a plan. 

6 (2) EXCHANGE.—The term ‘‘Exchange’’ means 

7 an American Health Benefit Exchange established 

8 under subtitle D of title I of the Patient Protection 

9 and Affordable Care Act (42 U.S.C. 18021 et seq.). 

10 (3) FAMILY SIZE.—The term ‘‘family size’’ has 

11 the meaning given such term in section 36B(d) of 

12 the Internal Revenue Code of 1986. 

13 (4) GROUP HEALTH PLAN.—The term ‘‘group 

14 health plan’’ has the meaning given such term in 

15 section 5000(b)(1) of the Internal Revenue Code of 

16 1986. 

17 (5) HOUSEHOLD INCOME.—The term ‘‘house18 hold income’’ has the meaning given such term in 

19 section 36B(d) of the Internal Revenue Code of 

20 1986. 

21 (6) HOUSEHOLD MEMBER.—The term ‘‘house22 hold member’’ means the taxpayer, the taxpayer’s 

23 spouse, and any dependent of the taxpayer. 


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1 (7) INSURANCE AFFORDABILITY PROGRAM.— 

2 The term ‘‘insurance affordability program’’ means 

3 any of the following: 

4 (A) A Medicaid program. 

5 (B) A CHIP program. 

6 (C) The program under title I of the Pa7 tient Protection and Affordable Care Act (42 

8 U.S.C. 18001 et seq.) for the enrollment in 

9 qualified health plans offered through an Ex10 change, including the premium tax credits 

11 under section 36B of the Internal Revenue 

12 Code of 1986, cost-sharing reductions under 

13 section 1402 of the Patient Protection and Af14 fordable Care Act (42 U.S.C. 18071), and the 

15 advance payment of such credits and reductions 

16 under section 1412(a)(3) of the Patient Protec17 tion and Affordable Care Act (42 U.S.C. 

18 18082(a)(3)). 

19 (D) A State basic health program under 

20 section 1331 of the Patient Protection and Af21 fordable Care Act (42 U.S.C. 18051). 

22 (E) Any other Federal, State, or local pro23 gram that provides assistance for some or all of 

24 the cost of minimum essential coverage and re25 quires eligibility for such program to be based 


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1 in whole or in part on income, including such 

2 a program carried out through a waiver under 

3 section 1332 of the Patient Protection and Af4 fordable Care Act (42 U.S.C. 18052) or a State 

5 program supplementing the advanced payment 

6 of tax credits and cost-sharing reductions under 

7 section 1412(a)(3) of such Act. 

8 (8) MEDICAID PROGRAM.—The term ‘‘Medicaid 

9 program’’ means a State plan for medical assistance 

10 under title XIX of the Social Security Act (42 

11 U.S.C. 1396 et seq.), including any waiver of such 

12 a plan. 

13 (9) MINIMUM ESSENTIAL COVERAGE.—The 

14 term ‘‘minimum essential coverage’’ has the meaning 

15 given such term in section 5000A(f) of the Internal 

16 Revenue Code of 1986. 

17 (10) MODIFIED ADJUSTED GROSS INCOME.— 

18 The term ‘‘modified adjusted gross income’’ has the 

19 meaning given such term in section 36B(d)(2)(B) of 

20 the Internal Revenue Code of 1986. 

21 (11) NET PREMIUM.—The term ‘‘net pre22 mium’’, with respect to a health plan or other form 

23 of minimum essential coverage— 

24 (A) except as provided in subparagraph 

25 (B), means the payment from or on behalf of 


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1 an individual required to enroll in such plan or 

2 coverage, after application of the premium tax 

3 credit under section 36B of the Internal Rev4 enue Code of 1986, the advance payment of 

5 such credit under section 1412(a)(3) of the Pa6 tient Protection and Affordable Care Act (42 

7 U.S.C. 18082(a)(3)), and any other assistance 

8 provided by an insurance affordability program; 

9 and 

10 (B) does not include any amounts de11 scribed in section 36B(b)(3)(D) of the Internal 

12 Revenue Code of 1986 or section 1303(b)(2) of 

13 the Patient Protection and Affordable Care Act 

14 (42 U.S.C. 18023(b)(2)). 

15 (12) POVERTY LINE.—The term ‘‘poverty line’’ 

16 has the meaning given such term in section 

17 36B(d)(3) of the Internal Revenue Code of 1986. 

18 (13) QUALIFIED HEALTH PLAN.—The term 

19 ‘‘qualified health plan’’ has the meaning given such 

20 term in section 1301(a) of the Patient Protection 

21 and Affordable Care Act (42 U.S.C. 18021(a)). 

22 (14) RELEVANT RETURN INFORMATION.—The 

23 term ‘‘relevant return information’’ means, with re24 spect to a taxpayer, any return information, as de25 fined in section 6103(b)(2) of the Internal Revenue 


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1 Code of 1986, which may be relevant, as determined 

2 by the Secretary of the Treasury in consultation 

3 with the Secretary of Health and Human Services, 

4 with respect to— 

5 (A) determining, or facilitating determina6 tion of, the eligibility of any household member 

7 of the taxpayer for any insurance affordability 

8 program, either directly or through enabling ac9 cess to additional information potentially rel10 evant to such eligibility; or 

11 (B) enrolling, or facilitating the enrollment 

12 of, such individual in minimum essential cov13 erage. 

14 (15) SINGLE, STREAMLINED APPLICATION.— 

15 The term ‘‘single, streamlined application’’ means 

16 the form described in section 1413(b)(1)(A) of the 

17 Patient Protection and Affordable Care Act (42 

18 U.S.C. 18083(b)(1)(A)). 

19 (16) TAX RETURN PREPARER.—The term ‘‘tax 

20 return preparer’’ has the meaning given such term 

21 in section 7701(a)(36) of the Internal Revenue Code 

22 of 1986. 

23 (17) ZERO NET PREMIUM.—The term ‘‘zero net 

24 premium’’, with respect to a health plan or other 


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1 form of minimum essential coverage, means a net 

2 premium of $0.00 for such plan or coverage. 

3 SEC. 3. FEDERAL INCOME TAX RETURNS USED TO FACILI4 TATE ENROLLMENT INTO INSURANCE AF5 FORDABILITY PROGRAMS. 

6 (a) IN GENERAL.—Not later than January 1, 2026, 

7 the Secretary shall establish a program which allows any 

8 taxpayer who is not covered under minimum essential cov9 erage at the time their return of tax for the taxable year 

10 is filed, as well as any other household member who is 

11 not covered under such coverage, to, in conjunction with 

12 the filing of their return of tax for any taxable year which 

13 begins after December 31, 2024, elect to— 

14 (1) have a determination made as to whether 

15 the household member who is not covered under 

16 such coverage is eligible for an insurance afford17 ability program; and 

18 (2) have such household member enrolled into 

19 minimum essential coverage, provided that— 

20 (A) such coverage is provided through a 

21 zero-net-premium plan, and 

22 (B) the taxpayer does not— 

23 (i) opt out of coverage through the 

24 zero-net-premium plan, or 

25 (ii) select a different plan. 


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1 (b) TAXPAYER REQUIREMENTS AND CONSENT.— 

2 (1) IN GENERAL.—Pursuant to the program es3 tablished under subsection (a), the taxpayer may, in 

4 conjunction with the filing of their return of tax for 

5 the taxable year— 

6 (A) identify any household member who is 

7 not covered under minimum essential coverage 

8 at the time of such filing; and 

9 (B) with respect to each household member 

10 identified under subparagraph (A), elect wheth11 er to— 

12 (i) in accordance with section 

13 6103(l)(23) of the Internal Revenue Code 

14 of 1986 (as added by subsection (f)), con15 sent to the disclosure and transfer to the 

16 applicable Exchange of any relevant return 

17 information for purposes of determining 

18 whether such household member may be el19 igible for any insurance affordability pro20 gram and facilitating enrollment into such 

21 program and minimum essential coverage, 

22 including any further disclosure and trans23 fer by the Exchange to any other entity as 

24 is deemed necessary to accomplish such 

25 purposes; and 


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1 (ii) in the case consent is provided 

2 under clause (i) with respect to such 

3 household member, enroll such household 

4 member in any minimum essential cov5 erage that is available with a zero net pre6 mium, if— 

7 (I) the member is eligible for 

8 such coverage through an insurance 

9 affordability program; and 

10 (II) the member does not, by the 

11 end of the special enrollment period 

12 described in section 4(c)(1)(A)— 

13 (aa) select a different plan 

14 offering minimum essential cov15 erage; or 

16 (bb) opt out of such cov17 erage that is available with a zero 

18 net premium. 

19 (2) ESTABLISHMENT OF OPTIONS FOR TAX20 PAYER CONSENT AND ELECTION.—For purposes of 

21 paragraph (1)(B), the Secretary, in consultation 

22 with the Secretary of Health and Human Services, 

23 may provide the elections under such paragraph as 

24 a single election or as 2 elections. 

25 (3) SUPPLEMENTAL FORM.— 


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1 (A) IN GENERAL.—In the case of a tax2 payer who has consented to disclosure and 

3 transfer of relevant return information pursu4 ant to paragraph (1)(B)(i), such taxpayer shall 

5 be enrolled in the insurance affordability pro6 gram only if the taxpayer submits a supple7 mental form which is designed to collect addi8 tional information necessary (as determined by 

9 the Secretary of Health and Human Services) 

10 to establish eligibility for and enrollment in an 

11 insurance affordability program, which may in12 clude (except as provided in subparagraph (B)), 

13 with respect to each individual described in 

14 paragraph (1)(A), the following: 

15 (i) State of residence. 

16 (ii) Date of birth. 

17 (iii) Employment and the availability 

18 of benefits under a group health plan at 

19 the time the return of tax is filed. 

20 (iv) Any changed circumstances de21 scribed in section 1412(b)(2) of the Pa22 tient Protection and Affordable Care Act; 

23 (42 U.S.C. 18082(b)(2)). 

24 (v) Solely for the purpose of facili25 tating automatic renewal of coverage and 


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1 eligibility redeterminations under section 

2 1413(c)(3)(A) of such Act (42 U.S.C. 

3 18083(c)(3)(A)), authorization for the Sec4 retary to disclose relevant return informa5 tion for subsequent taxable years to insur6 ance affordability programs. 

7 (vi) Any methods preferred by the 

8 taxpayer or household member for the pur9 pose of being contacted by the applicable 

10 Exchange or insurance affordability pro11 gram with respect to any eligibility deter12 mination for, or enrollment in, an insur13 ance affordability program or minimum es14 sential coverage, such as an email address 

15 or a phone number for calls or text mes16 sages. 

17 (vii) Information about household 

18 composition that— 

19 (I) may affect eligibility for an 

20 insurance affordability program; and 

21 (II) is not otherwise included on 

22 the return of tax. 

23 (viii) Such other information as the 

24 Secretary, in consultation with the Sec25 retary of Health and Human Services, may 


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1 require, including information requested on 

2 the single, streamlined application. 

3 (B) LIMITATIONS.—The information ob4 tained through the form described in subpara5 graph (A) may not include any request for in6 formation with respect to citizenship, immigra7 tion status, or health status of any household 

8 member. 

9 (C) ADDITIONAL INFORMATION.—The 

10 form described in subparagraph (A) and the ac11 companying tax instructions may provide the 

12 taxpayer with additional information about in13 surance affordability programs, including infor14 mation provided to applicants on the single, 

15 streamlined application. 

16 (D) ACCESSIBILITY.— 

17 (i) IN GENERAL.—The Secretary shall 

18 ensure that the form described in subpara19 graph (A) is made available to all tax20 payers without discrimination based on 

21 language, disability, literacy, or internet 

22 access. 

23 (ii) RULE OF CONSTRUCTION.—Noth24 ing in clause (i) shall be construed as di25 minishing, reducing, or otherwise limiting 


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1 any other legal obligation for the Secretary 

2 to avoid or to prevent discrimination. 

3 (4) RETURN LANGUAGE.—The Secretary, in 

4 consultation with the Secretary of Health and 

5 Human Services, shall, with respect to any items de6 scribed in this subsection which are to be included 

7 in a taxpayer’s return of tax, develop language for 

8 such items which is as simple and clear as possible 

9 (such as referring to ‘‘insurance affordability pro10 grams’’ as ‘‘free or low-cost health insurance’’). 

11 (c) TAX RETURN PREPARERS.— 

12 (1) IN GENERAL.—With respect to any infor13 mation submitted in conjunction with a tax return 

14 solely for purposes of the program described in sub15 section (a), any tax return preparer involved in pre16 paring the return containing such information shall 

17 not be obligated to assess the accuracy of such infor18 mation as provided by the taxpayer. 

19 (2) SUBMISSION OF INFORMATION.—As part of 

20 the program described in subsection (a), the Sec21 retary shall establish methods to allow for the imme22 diate transfer of any relevant return information to 

23 the applicable Exchange and insurance affordability 

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1 ment in insurance affordability programs and min2 imum essential coverage. 

3 (d) TRANSFER OF INFORMATION THROUGH SECURE

4 INTERFACE.— 

5 (1) IN GENERAL.—As part of the program es6 tablished under subsection (a), the Secretary shall 

7 develop a secure, electronic interface allowing an ex8 change of relevant return information with the appli9 cable Exchange in a manner similar to the interface 

10 described in section 1413(c)(1) of the Patient Pro11 tection and Affordable Care Act (42 U.S.C. 

12 18083(c)(1)). Upon receipt of such information, the 

13 applicable Exchange may convey such information to 

14 any other entity as needed to facilitate determina15 tion of eligibility for an insurance affordability pro16 gram or enrollment into minimum essential cov17 erage. 

18 (2) TRANSFER BY TREASURY OR TAX PRE19 PARERS.— 

20 (A) IN GENERAL.—The interface described 

21 in paragraph (1) shall allow, for any taxpayer 

22 who has provided consent pursuant to sub23 section (b)(1)(B)(i), for relevant return infor24 mation, along with confirmation that the Sec25 retary has accepted the return filing as meeting 


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1 applicable processing criteria, to be transferred 

2 to an applicable Exchange by— 

3 (i) the Secretary; or 

4 (ii) pursuant to such requirements 

5 and standards as are established by the 

6 Secretary (in consultation with the Sec7 retary of Health and Human Services)— 

8 (I) if the Secretary is not able to 

9 transfer such information to the appli10 cable Exchange, the taxpayer; or 

11 (II) the tax return preparer who 

12 prepared the return containing such 

13 information. 

14 (B) TRANSFER REQUIREMENTS.—As soon 

15 as is practicable after the filing of a return de16 scribed in subsection (a) in which the taxpayer 

17 has provided consent pursuant to subsection 

18 (b)(1)(B)(i), the Secretary shall provide for all 

19 relevant return information to be transferred to 

20 the applicable Exchange. 

21 (C) DATA SECURITY.—Any transfer of rel22 evant return information described in this sub23 section shall be conducted— 

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1 tain privacy in a manner that satisfies the 

2 requirements under section 1942(b) of the 

3 Social Security Act (42 U.S.C. 1396w– 

4 2(b)); and 

5 (ii) in the case of any taxpayer filing 

6 their tax return electronically, in a manner 

7 that maximizes the opportunity for such 

8 taxpayer, as part of the process of filing 

9 such return, to immediately— 

10 (I) obtain a determination with 

11 respect to the eligibility of any house12 hold member for any insurance af13 fordability program; and 

14 (II) enroll in minimum essential 

15 coverage. 

16 (e) ERRORS THAT AFFECT ELIGIBILITY FOR INSUR17 ANCE AFFORDABILITY PROGRAMS.—The Secretary of 

18 Health and Human Services, in consultation with the Sec19 retary, shall establish procedures for addressing instances 

20 in which an error in relevant return information that was 

21 transferred to an Exchange under subsection (d) may have 

22 resulted in a determination that an individual is eligible 

23 for more or less assistance under an insurance afford24 ability program than the assistance for which the indiVerDate Sep 11 2014 03:36 Mar 10, 2023 Jkt 039200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H1113.IH H1113

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1 vidual would otherwise have been eligible without the 

2 error. Such procedures shall include procedures for— 

3 (1) the reporting of such error to the individual, 

4 the Secretary of Health and Human Services, and 

5 the applicable Exchange and insurance affordability 

6 program, regardless of whether such error was in7 cluded in an amendment to the tax return; and 

8 (2) correcting, as soon as practicable, the indi9 vidual’s eligibility status for insurance affordability 

10 programs, subject to, in the case of reduced eligi11 bility for assistance, any right of notice and appeal 

12 under laws governing the applicable insurance af13 fordability program, including section 1411(f) of the 

14 Patient Protection and Affordable Care Act (42 

15 U.S.C. 18081(f)). 

16 (f) DISCLOSURE OF RETURN INFORMATION FOR DE17 TERMINING ELIGIBILITY FOR INSURANCE AFFORD18 ABILITY PROGRAMS AND ENROLLMENT INTO MINIMUM

19 ESSENTIAL HEALTH COVERAGE.— 

20 (1) IN GENERAL.—Section 6103(l) of the Inter21 nal Revenue Code of 1986 is amended by adding at 

22 the end the following: 

23 ‘‘(23) DISCLOSURE OF RETURN INFORMATION

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1 FORDABILITY PROGRAMS AND ENROLLMENT INTO

2 MINIMUM ESSENTIAL HEALTH COVERAGE.— 

3 ‘‘(A) IN GENERAL.—In the case of any 

4 taxpayer who has consented to the disclosure 

5 and transfer of any relevant return information 

6 with respect to any household member pursuant 

7 to section 3(b) of the Easy Enrollment in 

8 Health Care Act, the Secretary shall disclose 

9 such information to the applicable Exchange. 

10 ‘‘(B) RESTRICTION ON DISCLOSURE.—Re11 turn information disclosed under subparagraph 

12 (A) may be— 

13 ‘‘(i) used by an Exchange only for the 

14 purposes of, and to the extent necessary 

15 in— 

16 ‘‘(I) determining eligibility for an 

17 insurance affordability program, or 

18 ‘‘(II) facilitating enrollment into 

19 minimum essential coverage, and 

20 ‘‘(ii) further disclosed by an Exchange 

21 to any other person only for the purposes 

22 of, and to the extent necessary, to carry 

23 out subclauses (I) and (II) of clause (i). 

24 ‘‘(C) DEFINITIONS.—For purposes of this 

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1 tion’, ‘Exchange’, ‘insurance affordability pro2 gram’, and ‘minimum essential coverage’ have 

3 the same meanings given such terms under sec4 tion 2 of the Easy Enrollment in Health Care 

5 Act.’’. 

6 (2) SAFEGUARDS.—Section 6103(p)(4) of the 

7 Internal Revenue Code of 1986 is amended by in8 serting ‘‘or any Exchange described in subsection 

9 (l)(23),’’ after ‘‘or any entity described in subsection 

10 (l)(21),’’ each place it appears. 

11 (g) APPLICATIONS FOR INSURANCE AFFORDABILITY

12 PROGRAMS WITHOUT RELIANCE ON FEDERAL INCOME

13 TAX RETURNS.— 

14 (1) RULE OF CONSTRUCTION.—Nothing in this 

15 Act shall be construed as requiring any individual, 

16 as a condition of applying for an insurance afford17 ability program, to— 

18 (A) file a return of tax for any taxable 

19 year for which filing a return of tax would not 

20 otherwise be required for such taxable year; or 

21 (B) consent to disclosure of relevant return 

22 information under subsection (b)(1)(B)(i). 

23 (2) METHODS AND PROCEDURES.—Any agency 

24 administering an insurance affordability program 

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1 scribed by the Secretary of Health and Human Serv2 ices, in consultation with the Secretary, through 

3 which, in the case of an individual applying for an 

4 insurance affordability program without filing a re5 turn of tax or consenting to disclosure of relevant 

6 return information under subsection (b)(1)(B)(i), 

7 the program determines household income and fam8 ily size for— 

9 (A) a calendar year described in section 

10 1902(e)(14)(D)(vii)(I) of the Social Security 

11 Act (42 U.S.C. 1396a), as added by section 

12 5(a); and 

13 (B) an applicable taxable year, as defined 

14 in section 36B(c)(5) of the Internal Revenue 

15 Code of 1986 (as added by section 5(b)). 

16 (h) SECRETARY.—In this section, the term ‘‘Sec17 retary’’ means the Secretary of the Treasury, or the Sec18 retary’s delegate. 

19 SEC. 4. EXCHANGE USE OF RELEVANT RETURN INFORMA20 TION. 

21 (a) IN GENERAL.—An Exchange that receives rel22 evant return information under section 3(d) with respect 

23 to a taxpayer who has provided consent under section 

24 3(b)(1)(B) shall— 


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1 (1) minimize additional information (if any) 

2 that is required to be provided by such taxpayer for 

3 a household member to qualify for any insurance af4 fordability program by, whenever feasible, qualifying 

5 such household member for such program based 

6 on— 

7 (A) relevant information provided on the 

8 tax return filed by the taxpayer, including in9 formation on the supplemental form described 

10 in section 3(b)(3); and 

11 (B) information from other reliable third12 party data sources that is relevant to eligibility 

13 for such program but not available from the re14 turn, including information obtained through 

15 data matching based on social security num16 bers, other identifying information, and other 

17 items obtained from such return; 

18 (2) determine the eligibility of any household 

19 member for the CHIP program and, where eligibility 

20 is determined based on modified adjusted gross in21 come, the Medicaid program, as required under sec22 tion 1413 of the Patient Protection and Affordable 

23 Care Act (42 U.S.C. 18083) and section 1943 of the 

24 Social Security Act (42 U.S.C. 1396w–3), subject to 

25 any right of notice and appeal under laws governing 


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1 such programs, including section 1411(f) of the Pa2 tient Protection and Affordable Care Act (42 U.S.C. 

3 18081(f)); 

4 (3) to the extent that any additional informa5 tion is necessary for determining the eligibility of 

6 any household member for an insurance affordability 

7 program, obtain such information in the manner 

8 that— 

9 (A) imposes the lowest feasible procedural 

10 burden to the taxpayer, including— 

11 (i) in the case of a taxpayer filing 

12 their tax return electronically, online col13 lection of such information at or near the 

14 time of such filing; and 

15 (ii) prior to a denial of eligibility or 

16 enrollment due to failure to provide such 

17 information, attempting to contact the tax18 payer multiple times using the preferred 

19 contact methods described in section 

20 3(b)(3)(A)(vi); and 

21 (B) provides the individual with all proce22 dural protections that would otherwise be avail23 able in applying for such program, including 

24 the reasonable opportunity period described in 


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1 section 1137(d)(4)(A) of the Social Security 

2 Act (42U.S.C. 1320b–7(d)(4)(A)); and 

3 (4) when an individual is found eligible for an 

4 insurance affordability program other than the Med5 icaid program— 

6 (A) enable such individual, through proce7 dures prescribed by the Secretary of Health and 

8 Human Services, to seek coverage under the 

9 Medicaid program or CHIP program by pro10 viding additional information demonstrating po11 tential eligibility for such program, with any re12 sulting determination subject to rights of notice 

13 and appeal under laws governing insurance af14 fordability programs, including section 1411(f) 

15 of the Patient Protection and Affordable Care 

16 Act (42 U.S.C. 18081(f)); and 

17 (B) provide such individual with notice of 

18 such procedures. 

19 (b) MEDICAID AND CHIP.— 

20 (1) STATE OPTIONS.— 

21 (A) IN GENERAL.—In a State for which 

22 the Secretary of Health and Human Services is 

23 determining eligibility for individuals who apply 

24 for insurance affordability programs at the Ex25 change serving residents of the individual’s 


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1 State, the Secretary of Health and Human 

2 Services shall present the State with not less 

3 than 3 sets of options for verification proce4 dures and business rules that the Exchange 

5 serving residents of such State shall use in de6 termining eligibility for the State Medicaid pro7 gram and CHIP program with respect to indi8 viduals who are household members described 

9 in section 3(b)(1)(B). Notwithstanding any 

10 other provision of law, the Secretary of Health 

11 and Human Services may present each State 

12 with the same 3 sets of options, provided that 

13 each set can be customized to reflect each 

14 State’s decisions about optional eligibility cat15 egories and criteria for the Medicaid program 

16 and CHIP program. 

17 (B) BUSINESS RULES.—The business rules 

18 described in subparagraph (A) shall specify de19 tailed eligibility determination rules and proce20 dures for processing initial applications and re21 newals, including— 

22 (i) the Secretary’s use of data from 

23 State agencies and other sources described 

24 in subsection (c)(3)(A)(ii) of section 1413 


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1 of the Patient Protection and Affordable 

2 Care Act (42 U.S.C. 18083); and 

3 (ii) the circumstances for administra4 tive renewal of eligibility for the Medicaid 

5 program and the CHIP program, based on 

6 data showing probable continued eligibility. 

7 (C) DEFAULT.—In the case of a State de8 scribed in subparagraph (A) that does not se9 lect an option from the set presented under 

10 such subparagraph within a timeframe specified 

11 by the Secretary of Health and Human Serv12 ices, the Secretary of Health and Human Serv13 ices shall determine the option that the Ex14 change shall use for such State for the purposes 

15 described in such subparagraph. 

16 (D) RULE OF CONSTRUCTION.—Nothing in 

17 this paragraph shall be construed as requiring 

18 a State to provide benefits under title XIX or 

19 XXI of the Social Security Act (42 U.S.C. 1396 

20 et seq., 1397aa et seq.) to a category of individ21 uals, or to set an income eligibility threshold for 

22 benefits under such titles at a certain level, if 

23 the State is not otherwise required to do so 

24 under such titles. 

25 (2) ENROLLMENT.— 


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1 (A) IN GENERAL.—If the Exchange in a 

2 State determines that an individual described in 

3 paragraph (1)(A) is eligible for benefits under 

4 the State Medicaid program or CHIP program, 

5 the Exchange shall send the relevant informa6 tion about the individual to the State and, if 

7 consent has been given under section 

8 3(b)(1)(B) to enrollment in a health plan or 

9 other form of minimum essential coverage with 

10 a zero net premium, the State shall enroll such 

11 individual in the State Medicaid program or 

12 CHIP program (as applicable) as soon as prac13 ticable, except as provided in subparagraphs 

14 (B) and (D). 

15 (B) EXCEPTION.—A State shall not enroll 

16 an individual in coverage under the State Med17 icaid program or CHIP program without the af18 firmative consent of the individual if the indi19 vidual would be required to pay a premium for 

20 such coverage. 

21 (C) MANAGED CARE.—If the State Med22 icaid program or CHIP program requires an in23 dividual enrolled under subparagraph (A) to re24 ceive coverage through a managed care organi25 zation or entity, the State shall use a procedure 


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1 for assigning the individual to such an organi2 zation or entity (including auto-assignment pro3 cedures) that is commonly used in the State 

4 when an individual who is found eligible for 

5 such program does not affirmatively select a 

6 particular organization or entity. 

7 (D) OPT-OUT PROCEDURES.—Notwith8 standing subparagraph (A), an individual de9 scribed in such subparagraph shall be given one 

10 or more opportunities to opt out of coverage 

11 under a State Medicaid program or CHIP pro12 gram, using procedures prescribed by the Sec13 retary of Health and Human Services. 

14 (c) ADVANCE PREMIUM TAX CREDITS FOR QUALI15 FIED HEALTH PLANS.— 

16 (1) IN GENERAL.—In the case where a taxpayer 

17 has filed their return of tax for a taxable year on or 

18 before the date specified under section 6072(a) of 

19 the Internal Revenue Code of 1986 with respect to 

20 such year and has provided consent described in sec21 tion 3(b)(1)(B)(i), if the Exchange has determined 

22 that an applicable household member has not quali23 fied for the Medicaid program or the CHIP pro24 gram, such Exchange shall— 


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1 (A) in addition to any such period that 

2 may otherwise be available, provide a special 

3 enrollment period that begins on the date the 

4 taxpayer has provided such consent; and 

5 (B) determine— 

6 (i) whether the taxpayer would, pursu7 ant to section 1412 of the Patient Protec8 tion and Affordable Care Act (42 U.S.C. 

9 18082), be eligible for advance payment of 

10 the premium assistance tax credit under 

11 section 36B of the Internal Revenue Code 

12 of 1986 if such household member of the 

13 taxpayer were enrolled in a qualified health 

14 plan; and 

15 (ii) if the taxpayer has made the elec16 tion described in section 3(b)(1)(B)(ii), 

17 whether such household member has one 

18 or more options to enroll in a qualified 

19 health plan with a zero net premium. 

20 (2) ENROLLMENT IN A QUALIFIED HEALTH

21 PLAN WITH A ZERO NET PREMIUM.— 

22 (A) IN GENERAL.—In the case that a 

23 household member described in paragraph (1) 

24 has one or more options to enroll in a qualified 

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1 sent has been given under section 3(b)(1)(B) 

2 for enrollment of such household member in a 

3 qualified health plan with a zero net premium— 

4 (i) the Exchange shall identify a set of 

5 options (as described in subparagraph (B)) 

6 for qualified health plans offering a zero 

7 net premium; and 

8 (ii) from such set, select a qualified 

9 health plan as the default enrollment 

10 choice for the household member in accord11 ance with subparagraph (C). 

12 (B) OPTION SETS.— 

13 (i) IN GENERAL.—In the case that 

14 multiple qualified health plans with a zero 

15 net premium are available with more than 

16 1 actuarial value, the Exchange shall limit 

17 the set of options under subparagraph 

18 (A)(i) to such qualified health plans with 

19 the highest available actuarial value. 

20 (ii) FURTHER RESTRICTIONS.—In the 

21 case described in clause (i), the Exchange 

22 may further limit the set of options under 

23 subparagraph (A)(i), among the qualified 

24 health plans that have the highest available 

25 actuarial value as described in clause (i), 


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1 based on the generosity of such plans’ cov2 erage of services not subject to a deduct3 ible. 

4 (iii) DEFINITION OF HIGHEST ACTU5 ARIAL VALUE.—For purposes of this sub6 paragraph, the term ‘‘highest actuarial 

7 value’’ means the highest actuarial value 

8 among— 

9 (I) the levels of coverage de10 scribed in paragraph (1) of section 

11 1302(d) of the Patient Protection and 

12 Affordable Care Act (42 U.S.C. 

13 18022(d)), without regard to allow14 able variance under paragraph (3) of 

15 such section; and 

16 (II) as applicable, the levels of 

17 coverage that result from the applica18 tion of cost-sharing reductions under 

19 section 1402 of such Act (42 U.S.C. 

20 18071). 

21 (C) SELECTING A DEFAULT OPTION.—The 

22 Secretary of Health and Human Services shall 

23 establish procedures that Exchanges may use in 

24 selecting, from the set of options described in 

25 subparagraph (B), the default enrollment choice 


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1 under subparagraph (A)(ii). Such procedures 

2 shall include— 

3 (i) State options for randomization 

4 among health insurance issuers; and 

5 (ii) factors that may be used to weight 

6 such randomization. 

7 (D) NOTIFICATION OF DEFAULT ENROLL8 MENT.—As soon as possible after an Exchange 

9 has identified a default enrollment choice for an 

10 individual under subparagraph (A)(ii), the Ex11 change shall provide the individual with notice 

12 of such selection. The notice shall include— 

13 (i) a description of coverage provided 

14 by the selected qualified health plan; 

15 (ii) encouragement to learn about all 

16 available qualified health plan options be17 fore the end of the special enrollment pe18 riod under paragraph (1)(A) and to select 

19 a plan that best meets the needs of the in20 dividual and the individual’s family; 

21 (iii) an explanation that, if the indi22 vidual does not select a qualified health 

23 plan by the end of such special enrollment 

24 period or opt out of default enrollment in 

25 accordance with the process described in 


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1 clause (iv), the Exchange will enroll the in2 dividual in such selected qualified health 

3 plan in accordance with subparagraph (E); 

4 (iv) an explanation of the opt-out 

5 process preceding implementation of de6 fault enrollment, which shall meet stand7 ards prescribed by the Secretary of Health 

8 and Human Services; and 

9 (v) information on options for assist10 ance with enrollment and plan choice, in11 cluding publicly funded navigators and pri12 vate brokers and agents approved by the 

13 Exchange. 

14 (E) DEFAULT ENROLLMENT.— 

15 (i) IN GENERAL.—Subject to subpara16 graph (F), an Exchange shall enroll in a 

17 default enrollment choice any individual 

18 who— 

19 (I) is sent a notice under sub20 paragraph (D); and 

21 (II) fails to select a different 

22 qualified health plan, or opt out of de23 fault enrollment under this paragraph, 

24 by the end of the special enrollment 

25 period described in paragraph (1)(A). 


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1 (ii) UPDATED NOTICE.—At the time 

2 of the default enrollment described in 

3 clause (i), the Exchange shall send a notice 

4 to the individual explaining that default 

5 enrollment has occurred, describing the 

6 plan into which the individual has been en7 rolled, and explaining the reconsideration 

8 procedures described in subparagraph (F). 

9 (F) RECONSIDERATION.— 

10 (i) IN GENERAL.—Not later than 30 

11 days after receiving a notice under sub12 paragraph (E)(ii), the individual receiving 

13 such notice may use a method provided by 

14 the Exchange to indicate— 

15 (I) the individual’s decision to 

16 disenroll from the qualified health 

17 plan selected under subparagraph 

18 (A)(ii); or 

19 (II) in the case of a household 

20 member for whom the selected quali21 fied health plan under such subpara22 graph is a high cost-sharing qualified 

23 health plan, the individual’s decision 

24 to enroll in a specified lower cost25 sharing qualified health plan, identiVerDate Sep 11 2014 03:36 Mar 10, 2023 Jkt 039200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\H1113.IH H1113

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1 fied by the Exchange, that is offered 

2 by the same health insurance issuer 

3 that sponsors the qualified health plan 

4 that was selected under such subpara5 graph. 

6 (ii) DEFINITIONS.—For purposes of 

7 this subparagraph: 

8 (I) HIGH COST-SHARING QUALI9 FIED HEALTH PLAN.—The term ‘‘high 

10 cost-sharing qualified health plan’’ 

11 means— 

12 (aa) in the case of a house13 hold member with a household 

14 income at or below 200 percent 

15 of the poverty line, a qualified 

16 health plan that is not at the sil17 ver level; or 

18 (bb) in the case of a house19 hold member with a household 

20 income above 200 percent of the 

21 poverty line, a qualified health 

22 plan that is not at the gold or 

23 platinum level. 

24 (II) SPECIFIED LOWER COST25 SHARING QUALIFIED HEALTH PLAN.— 


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1 The term ‘‘specified lower cost-shar2 ing qualified health plan’’ means— 

3 (aa) in the case of a house4 hold member with a household 

5 income at or below 200 percent 

6 of the poverty line, the lowest7 premium qualified health plan of8 fered by the health insurance 

9 issuer that is at the silver level; 

10 or 

11 (bb) in the case of a house12 hold member with a household 

13 income above 200 percent of the 

14 poverty line, the lowest-premium 

15 qualified health plan offered by 

16 the health insurance issuer that 

17 is at the gold level. 

18 SEC. 5. MODERNIZING ELIGIBILITY CRITERIA FOR INSUR19 ANCE AFFORDABILITY PROGRAMS. 

20 (a) INCOME ELIGIBILITY DETERMINATIONS FOR

21 MEDICAID AND CHIP.— 

22 (1) IN GENERAL.—Section 1902(e)(14)(D) of 

23 the Social Security Act (42 U.S.C. 1396a(e)(14)(D)) 

24 is amended by adding at the end the following new 

25 clauses: 


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1 ‘‘(vi) SNAP AND TANF ELIGIBILITY

2 FINDINGS.— 

3 ‘‘(I) IN GENERAL.—Subject to 

4 subclause (III), a State shall provide 

5 that an individual for whom a finding 

6 has been made as described in clause 

7 (II) shall meet applicable eligibility for 

8 assistance under the State plan or a 

9 waiver of the plan involving financial 

10 eligibility, citizenship or satisfactory 

11 immigration status, and State resi12 dence. A State shall rely on such a 

13 finding both for the initial determina14 tion of eligibility for medical assist15 ance under the plan or waiver and any 

16 subsequent redetermination of eligi17 bility. 

18 ‘‘(II) FINDINGS DESCRIBED.—A 

19 finding described in this subclause is 

20 a determination made within a rea21 sonable period (as determined by the 

22 Secretary) by a State agency respon23 sible for administering the Temporary 

24 Assistance for Needy Families pro25 gram under part A of title IV or the 


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1 Supplemental Nutrition Assistance 

2 Program established under the Food 

3 and Nutrition Act of 2008 that an in4 dividual is eligible for benefits under 

5 such program. 

6 ‘‘(III) LIMITATION.—A State 

7 shall be required to rely on the find8 ings of the State agency responsible 

9 for administering the supplemental 

10 nutrition assistance program estab11 lished under the Food and Nutrition 

12 Act of 2008 only in the case of— 

13 ‘‘(aa) an individual who is 

14 under 19 years of age; or 

15 ‘‘(bb) an individual who is 

16 described in subsection 

17 (a)(10)(A)(i)(VIII). 

18 ‘‘(IV) STATE OPTION.—A State 

19 may rely on the findings of the State 

20 agency responsible for administering 

21 the supplemental nutrition assistance 

22 program established under the Food 

23 and Nutrition Act of 2008 in the case 

24 of an individual not described in sub25 clause (III). 


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1 ‘‘(vii) RECENT ANNUAL INCOME ES2 TABLISHING ELIGIBILITY.— 

3 ‘‘(I) IN GENERAL.—For purposes 

4 of determining the income eligibility 

5 for medical assistance of an individual 

6 whose eligibility is determined based 

7 on the application of modified ad8 justed gross income under subpara9 graph (A), a State shall provide that 

10 an individual whose eligibility date oc11 curs in January, February, March, or 

12 April of a calendar year shall be fi13 nancially eligible if the individual’s 

14 modified adjusted gross income for 

15 the preceding calendar year satisfies 

16 the income eligibility requirement ap17 plicable to the individual. 

18 ‘‘(II) DEFINITION.—For pur19 poses of this clause, an ‘eligibility 

20 date’ means— 

21 ‘‘(aa) in the case of an indi22 vidual who is not receiving med23 ical assistance when the indi24 vidual applies for an insurance 

25 affordability program (as defined 


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•HR 1113 IH

1 in section 2 of the Easy Enroll2 ment in Health Care Act), 

3 whether such application takes 

4 place through section 3(b) of 

5 such Act or otherwise, the date 

6 on which such individual applies 

7 for such program; and 

8 ‘‘(bb) in the case of an indi9 vidual who is receiving medical 

10 assistance and whose continued 

11 eligibility for such assistance is 

12 being redetermined, the date on 

13 which the individual is deter14 mined to satisfy all eligibility re15 quirements applicable to the indi16 vidual other than income eligi17 bility. 

18 ‘‘(III) RULES OF CONSTRUC19 TION.— 

20 ‘‘(aa) ELIGIBILITY DETER21 MINATIONS DURING MAY

22 THROUGH DECEMBER.—Nothing 

23 in subclause (I) shall be con24 strued as diminishing, reducing, 

25 or otherwise limiting the State’s 


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1 obligation to grant eligibility, 

2 under circumstances other than 

3 those described in such sub4 clause, based on data that in5 clude income shown on an indi6 vidual’s tax return, including the 

7 obligation under section 

8 1413(c)(3)(A) of the Patient 

9 Protection and Affordable Care 

10 Act (42 U.S.C. 18083(c)(3)(A)). 

11 ‘‘(bb) ALTERNATIVE

12 GROUNDS FOR ELIGIBILITY.— 

13 Nothing in subclause (I) shall be 

14 construed as diminishing, reduc15 ing, or otherwise limiting 

16 grounds for eligibility other than 

17 those described in such sub18 clause, including eligibility based 

19 on income as of the point in time 

20 at which an application for med21 ical assistance under the State 

22 plan or a waiver of the plan is 

23 processed. 

24 ‘‘(cc) QUALIFYING FOR AD25 DITIONAL ASSISTANCE.—NotVerDate Sep 11 2014 03:36 Mar 10, 2023 Jkt 039200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\H1113.IH H1113

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1 withstanding subclause (I), a 

2 State shall use an individual’s 

3 modified adjusted gross income 

4 as determined as of the point in 

5 time at which the individual’s ap6 plication for medical assistance is 

7 processed or, in the case of rede8 termination of eligibility, pro9 jected annual income, to deter10 mine the individual’s eligibility 

11 for medical assistance if using 

12 the individual’s modified adjusted 

13 gross income, as so determined, 

14 would result in the individual 

15 being eligible for greater benefits 

16 under the State plan (or a waiver 

17 of such plan) or in the imposition 

18 of lower premiums or cost-shar19 ing on the individual under the 

20 plan (or waiver) than if the indi21 vidual’s eligibility was determined 

22 using the modified adjusted gross 

23 income of the individual as shown 

24 on the individual’s tax return for 

25 the preceding calendar year.’’. 


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1 (2) CONFORMING AMENDMENT.—Section 

2 1902(e)(14)(H)(i) of the Social Security Act (42 

3 U.S.C. 1396a(e)(14)(H)(i)) is amended by inserting 

4 ‘‘except as provided in subparagraph (D)(vii)(I),’’ 

5 before ‘‘the requirement’’. 

6 (3) EFFECTIVE DATE.—The amendments made 

7 by this subsection shall take effect on January 1, 

8 2025. 

9 (b) IMPROVING THE STABILITY AND PREDICT10 ABILITY OF EXCHANGE COVERAGE.— 

11 (1) INTERNAL REVENUE CODE OF 1986.—Sec12 tion 36B of the Internal Revenue Code of 1986 is 

13 amended— 

14 (A) in subsection (b)— 

15 (i) in paragraph (2)(B)(ii), by striking 

16 ‘‘taxable year’’ and inserting ‘‘applicable 

17 tax year’’, and 

18 (ii) in paragraph (3)— 

19 (I) in subparagraph (A)— 

20 (aa) in clause (i), by striking 

21 ‘‘taxable year’’ and inserting ‘‘ap22 plicable taxable year’’, and 

23 (bb) in clause (ii)(I), by in24 serting ‘‘(or, in the case of appli25 cable taxable years beginning in 


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1 any calendar year after 2025)’’ 

2 after ‘‘2014’’, and 

3 (II) in subparagraph (B)— 

4 (aa) in clause (ii)(I)(aa), by 

5 striking ‘‘the taxable year’’ each 

6 place it appears and inserting 

7 ‘‘the applicable taxable year’’, 

8 and 

9 (bb) in the flush matter at 

10 the end— 

11 (AA) striking ‘‘files a 

12 joint return and no credit is 

13 allowed’’ and inserting ‘‘filed 

14 a joint return during the ap15 plicable taxable year and no 

16 credit was allowed’’, and 

17 (BB) striking ‘‘unless a 

18 deduction is allowed under 

19 section 151 for the taxable 

20 year’’ and inserting ‘‘unless 

21 a deduction was allowed 

22 under section 151 for the 

23 applicable taxable year’’, 

24 (B) in subsection (c)— 

25 (i) in paragraph (1)— 


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1 (I) in subparagraphs (A) and 

2 (C), by striking ‘‘taxable year’’ each 

3 place it appears and inserting ‘‘appli4 cable taxable year’’, and 

5 (II) in subparagraph (D), by 

6 striking ‘‘is allowable’’ and all that 

7 follows through the period and insert8 ing ‘‘was allowable to another tax9 payer for the applicable taxable 

10 year.’’, 

11 (ii) in paragraph (2)(C), by adding at 

12 the end the following: 

13 ‘‘(v) TIME PERIOD.— 

14 ‘‘(I) IN GENERAL.—Except as 

15 provided under subclause (II), eligi16 bility for minimum essential coverage 

17 under this subparagraph shall be 

18 based on the individual’s eligibility for 

19 employer-sponsored minimum essen20 tial coverage during the open enroll21 ment period (or during a special en22 rollment period for an individual who 

23 enrolls or who changes their qualified 

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1 ment period), as determined by the 

2 applicable Exchange. 

3 ‘‘(II) EXCEPTION.—An individual 

4 shall be considered eligible for min5 imum essential coverage under clause 

6 (iii) for a month for which such Ex7 change has determined, subject to 

8 rights of notice and appeal under laws 

9 governing the applicable insurance af10 fordability program (including section 

11 1411(f) of the Patient Protection and 

12 Affordable Care Act (42 U.S.C. 

13 18081(f))), that the individual is cov14 ered by an eligible employer-sponsored 

15 plan.’’, and 

16 (iii) by adding at the end the fol17 lowing: 

18 ‘‘(5) APPLICABLE TAXABLE YEAR.—The term 

19 ‘applicable taxable year’ means— 

20 ‘‘(A) with respect to a coverage month that 

21 is January, February, March, April, or May, 

22 the most recent taxable year that ended at least 

23 12 months before January 1 of the plan year, 

24 and 


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1 ‘‘(B) with respect to any coverage month 

2 not described in subparagraph (A), the most re3 cent taxable year that ended before January 1 

4 of the plan year. 

5 ‘‘(6) EXCHANGE.—The term ‘Exchange’ means 

6 an American Health Benefit Exchange established 

7 under subtitle D of title I of the Patient Protection 

8 and Affordable Care Act (42 U.S.C. 18021 et seq.). 

9 ‘‘(7) OPEN ENROLLMENT PERIOD.—The term 

10 ‘open enrollment period’ means an open enrollment 

11 period described in subsection (c)(6)(B) of section 

12 1311 of the Patient Protection and Affordable Care 

13 Act (42 U.S.C. 18031).’’, 

14 (C) in subsection (d)— 

15 (i) in paragraph (1)— 

16 (I) by striking ‘‘is allowed’’ and 

17 inserting ‘‘was allowed’’, and 

18 (II) by inserting ‘‘applicable’’ be19 fore ‘‘taxable year’’, and 

20 (ii) in paragraph (3)(B), by inserting 

21 ‘‘applicable’’ before ‘‘taxable year’’, 

22 (D) in subsection (e)(1)— 

23 (i) by striking ‘‘is allowed’’ and insert24 ing ‘‘was allowed’’, and 


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1 (ii) by inserting ‘‘applicable’’ before 

2 ‘‘taxable year’’, and 

3 (E) in subsection (f)(2)— 

4 (i) in subparagraph (A), by striking 

5 ‘‘If’’ and inserting ‘‘Except as provided in 

6 subparagraphs (B) and (C), if’’, and 

7 (ii) by inserting at the end the fol8 lowing: 

9 ‘‘(C) SAFE HARBOR.— 

10 ‘‘(i) INCOME AND FAMILY SIZE.—No 

11 increase under subparagraph (A) shall be 

12 imposed if the advance payments do not 

13 exceed amounts that are consistent with 

14 income and family size, either— 

15 ‘‘(I) as shown on the return of 

16 tax for the applicable plan year, pro17 vided such return was accepted by the 

18 Secretary as meeting applicable proc19 essing criteria, or 

20 ‘‘(II) as determined by the appli21 cable Exchange under subsection 

22 (b)(4) of section 1412 of the Patient 

23 Protection and Affordable Care Act 

24 (42 U.S.C. 18082). 


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1 ‘‘(ii) EMPLOYER-SPONSORED MINIMUM

2 ESSENTIAL COVERAGE.—No increase under 

3 subparagraph (A) shall be imposed based 

4 on eligibility for minimum essential cov5 erage under subsection (c)(2)(C) if the ap6 plicable Exchange— 

7 ‘‘(I) determined, under clause 

8 (v)(I) of such subsection, that the in9 dividual was ineligible for employer10 sponsored minimum essential cov11 erage, and 

12 ‘‘(II) did not determine, under 

13 clause (v)(II) of such subsection, that 

14 the individual was covered through 

15 employer-sponsored minimum essen16 tial coverage. 

17 ‘‘(iii) EXCEPTION.—Clauses (i) and 

18 (ii) shall not apply to the extent that any 

19 determination described in such clauses 

20 was based on a false statement by the tax21 payer which— 

22 ‘‘(I) was intentional or grossly 

23 negligent, and 

24 ‘‘(II) was— 


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•HR 1113 IH

1 ‘‘(aa) made on a return of 

2 tax, or 

3 ‘‘(bb) provided or caused to 

4 be provided to an Exchange by 

5 the taxpayer.’’. 

6 (2) PATIENT PROTECTION AND AFFORDABLE

7 CARE ACT.—Section 1412(b) of the Patient Protec8 tion and Affordable Care Act (42 U.S.C. 18082(b)) 

9 is amended— 

10 (A) in paragraph (1)(B), by striking ‘‘the 

11 most recent’’ and all that follows through the 

12 period at the end and inserting ‘‘the applicable 

13 taxable year, as defined in section 36B(c)(5) of 

14 the Internal Revenue Code of 1986.’’; 

15 (B) in paragraph (2)(B), by striking ‘‘sec16 ond preceding taxable year’’ and inserting ‘‘ap17 plicable taxable year, as defined in such section 

18 36B(c)(5)’’; and 

19 (C) by adding at the end the following: 

20 ‘‘(3) CHANGE FORM.—If, after the submission 

21 of an individual’s application form, the individual ex22 periences changes in circumstances as described in 

23 paragraph (2), the individual may, by submitting a 

24 change form as prescribed by the Secretary, apply 

25 for an increased amount of advance payments of the 


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1 premium tax credit under section 36B of the Inter2 nal Revenue Code of 1986, increased cost-sharing 

3 reductions under section 1402, increased assistance 

4 under the basic health program under section 1331, 

5 and coverage through a State Medicaid program or 

6 CHIP program. 

7 ‘‘(4) ELIGIBILITY FOR ADDITIONAL ASSIST8 ANCE.— 

9 ‘‘(A) IN GENERAL.—The Secretary, in con10 sultation with the Secretary of the Treasury, 

11 shall establish a process through which— 

12 ‘‘(i) an Exchange determines, through 

13 data sources and procedures described in 

14 sections 1411 and 1413 (42 U.S.C. 18081; 

15 42 U.S.C. 18083), whether each individual 

16 who has submitted a change form under 

17 paragraph (3) has experienced substantial 

18 changes in circumstances that warrant ad19 ditional assistance through an insurance 

20 affordability program, as defined in section 

21 2 of the Easy Enrollment in Health Care 

22 Act; 

23 ‘‘(ii) in the case the Exchange deter24 mines an individual has experienced sub25 stantial changes in circumstances as deVerDate Sep 11 2014 03:36 Mar 10, 2023 Jkt 039200 PO 00000 Frm 00050 Fmt 6652 Sfmt 6201 E:\BILLS\H1113.IH H1113

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1 scribed in clause (i), the Exchange conveys 

2 such determination to the Secretary of the 

3 Treasury under section 36B(f) of the In4 ternal Revenue Code of 1986 and to the 

5 administrator of an insurance affordability 

6 program for which the individual may 

7 qualify under that determination; and 

8 ‘‘(iii) in the case the Exchange deter9 mines an individual has experienced sub10 stantial changes in circumstances described 

11 in clause (i), the individual may qualify 

12 without delay for additional advance pre13 mium tax credits under section 36B of the 

14 Internal Revenue Code of 1986, increased 

15 cost-sharing reductions under section 

16 1402, additional basic health program as17 sistance under section 1331, or coverage 

18 through a State Medicaid program or 

19 CHIP program. 

20 ‘‘(B) RIGHTS TO NOTICE AND APPEAL.—A 

21 determination made by an Exchange under this 

22 paragraph shall be subject to any applicable 

23 rights of notice and appeal, including such 

24 rights under section 1411(f).’’. 


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1 (3) EFFECTIVE DATES.—The amendments 

2 made by this subsection shall take effect on January 

3 1, 2026, and continue in effect through December 

4 31, 2032. 

5 SEC. 6. STRENGTHENING DATA INFRASTRUCTURE FOR ELI6 GIBILITY FOR INSURANCE AFFORDABILITY 

7 PROGRAMS. 

8 (a) INSURANCE AFFORDABILITY PROGRAM ACCESS

9 TO NATIONAL DIRECTORY OF NEW HIRES.—Section 

10 453(i) of the Social Security Act (42 U.S.C. 653(i)) is 

11 amended by adding at the end the following new para12 graph: 

13 ‘‘(5) ADMINISTRATION OF INSURANCE AFFORD14 ABILITY PROGRAMS.— 

15 ‘‘(A) IN GENERAL.—The Secretary shall 

16 provide access to insurance affordability pro17 grams (as such term is defined in section 2 of 

18 the Easy Enrollment in Health Care Act) to in19 formation in the National Directory of New 

20 Hires that involves— 

21 ‘‘(i) identity, employer, quarterly 

22 wages, and unemployment compensation, 

23 to the extent such information is poten24 tially relevant to determining the eligibility 


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1 or scope of coverage of an individual for 

2 benefits provided by such a program; and 

3 ‘‘(ii) new hires, to the extent such in4 formation is potentially relevant to deter5 mining whether an individual is offered 

6 minimum essential coverage through a 

7 group health plan, as defined in section 

8 5000(b)(1) of the Internal Revenue Code 

9 of 1986. 

10 ‘‘(B) REIMBURSEMENT OF HHS COSTS.— 

11 Insurance affordability programs shall reim12 burse the Secretary, in accordance with sub13 section (k)(3), for the additional costs incurred 

14 by the Secretary in furnishing information 

15 under this paragraph.’’. 

16 (b) USE OF INFORMATION FROM THE NATIONAL DI17 RECTORY OF NEW HIRES.—Notwithstanding any other 

18 provision of law— 

19 (1) in determining an individual’s eligibility for 

20 advance payment of premium tax credits under sec21 tion 1412(a)(3) of the Patient Protection and Af22 fordable Care Act (42 U.S.C. 18082(a)(3)), and 

23 cost-sharing reductions under section 1402 of the 

24 Patient Protection and Affordable Care Act (42 

25 U.S.C. 18071), and a basic health program under 


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1 section 1331 of the Patient Protection and Afford2 able Care Act (42 U.S.C. 18051), an Exchange may 

3 use information about identity, employer, quarterly 

4 wages, and unemployment compensation in the Na5 tional Directory of New Hires, and information 

6 about new hires to determine whether an individual 

7 is offered minimum essential coverage through a 

8 group health plan, as defined in section 5000(b)(1) 

9 of the Internal Revenue Code of 1986, subject to no10 tice and appeal rights for any resulting eligibility de11 termination, including the rights described in section 

12 1411(f) of the Patient Protection and Affordable 

13 Care Act (42 U.S.C. 18081(f)); and 

14 (2) Medicaid programs and CHIP programs 

15 may use information in the National Directory of 

16 New Hires about identity, employer, quarterly 

17 wages, and unemployment compensation to deter18 mine eligibility and to implement third-party liability 

19 procedures or premium assistance programs other20 wise permitted or mandated under Federal law, and 

21 use information about new hires to implement such 

22 procedures and policies, subject to notice and appeal 

23 rights for any resulting determination, including 

24 those available under title XIX or title XXI of the 

25 Social Security Act or under section 1411(f) of the 


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1 Patient Protection and Affordable Care Act (42 

2 U.S.C. 18081(f)). 

3 (c) USE OF INFORMATION ABOUT ELIGIBILITY FOR

4 OR RECEIPT OF GROUP HEALTH COVERAGE.—Notwith5 standing any other provision of Federal or State law: 

6 (1) IN GENERAL.—Subject to the requirements 

7 described in paragraph (2), for purposes of deter8 mining eligibility and, in the case of a Medicaid pro9 gram, for purposes of determining the applicability 

10 of third-party liability procedures or premium assist11 ance policies otherwise permitted or mandated under 

12 Federal law, an insurance affordability program 

13 shall have access to any source of information, main14 tained by or accessible to a public entity, about re15 ceipt or offers of coverage through a group health 

16 plan. Such sources shall include— 

17 (A) information maintained by or acces18 sible to the Secretary of Health and Human 

19 Services for purposes of implementing section 

20 1862(b) of the Social Security Act (42 U.S.C. 

21 1395y(b)); 

22 (B) information maintained by or acces23 sible to a State Medicaid program for purposes 

24 of implementing subsections (a)(25) or (a)(60) 


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1 of section 1902 of the Social Security Act (42 

2 U.S.C. 1396a); and 

3 (C) information reported under sections 

4 6055 and 6056 of the Internal Revenue Code of 

5 1986. 

6 (2) REQUIREMENTS.—An insurance afford7 ability program shall obtain the information de8 scribed in paragraph (1) pursuant to an interagency 

9 or other agreement, consistent with standards pre10 scribed by the Secretary of Health and Human Serv11 ices, in consultation with the Secretary, that pre12 vents the unauthorized use, disclosure, or modifica13 tion of such information and otherwise protects pri14 vacy and data security. 

15 (d) AUTHORIZATION TO RECEIVE RELEVANT INFOR16 MATION.— 

17 (1) IN GENERAL.—Notwithstanding any other 

18 provision of law, a Federal or State agency or pri19 vate entity in possession of the sources of data po20 tentially relevant to eligibility for an insurance af21 fordability program is authorized to convey such 

22 data or information to the insurance affordability 

23 program, and such program is authorized to receive 

24 the data or information and to use it in determining 

25 eligibility. 


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1 (2) APPLICATION OF REQUIREMENTS AND PEN2 ALTIES.—A conveyance of data to an insurance af3 fordability program under this subsection shall be 

4 subject to the same requirements that apply to a 

5 conveyance of data to a State Medicaid plan under 

6 title XIX of the Social Security Act (42 U.S.C. 1396 

7 et seq.) under section 1942 of such Act (42 U.S.C. 

8 1396w–2), and the penalties that apply to a viola9 tion of such requirements, including penalties that 

10 apply to a private entity making a conveyance. 

11 (e) ELECTRONIC TRANSMISSION OF INFORMATION.— 

12 In determining an individual’s eligibility for an insurance 

13 affordability program, the program shall— 

14 (1) with respect to verifying an element of eligi15 bility that is based on information from an Express 

16 Lane Agency (as defined in section 1902(e)(13)(F) 

17 of the Social Security Act (42 U.S.C. 

18 1396a(e)(13)(F))), from another public agency, or 

19 from another reliable source of relevant data, waive 

20 any otherwise applicable requirement that the indi21 vidual must verify such information, provide an at22 testation as to the subject of such information, or 

23 provide a signature for attestations that include that 

24 subject, before the individual is enrolled into min25 imum essential coverage; and 


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1 (2) satisfy any otherwise applicable signature 

2 requirement with respect to an individual’s enroll3 ment in an insurance affordability program through 

4 an electronic signature (as defined in section 

5 1710(1) of the Government Paperwork Elimination 

6 Act (44 U.S.C. 3504 note)). 

7 (f) RULE OF CONSTRUCTION.—Nothing in this sec8 tion shall be construed as diminishing, reducing, or other9 wise limiting the legal authority for an insurance afford10 ability program to grant eligibility, in whole or in part, 

11 based on an attestation alone, without requiring 

12 verification through data matches or other sources. 

13 SEC. 7. FUNDING FOR INFORMATION TECHNOLOGY DEVEL14 OPMENT AND OPERATIONS. 

15 (a) IN GENERAL.—Out of amounts in the Treasury 

16 not otherwise appropriated, there are appropriated to the 

17 Secretary of Health and Human Services such sums as 

18 may be necessary to establish information exchange and 

19 processing infrastructure and operate all information ex20 change and processing procedures described in this Act, 

21 including for the costs of staff and contractors. 

22 (b) AGENCIES RECEIVING FUNDING.—The Secretary 

23 of Health and Human Services may, as necessary and in 

24 accordance with the procedures described in subsection 

25 (c), transfer amounts appropriated under subsection (a) 


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1 to entities that include the following for the purposes de2 scribed in such subsection: 

3 (1) The Secretary of the Treasury, including 

4 the Internal Revenue Service. 

5 (2) The Office of Child Support Enforcement of 

6 the Department of Health and Human Services. 

7 (3) A State-administered insurance affordability 

8 program, including a Medicaid or CHIP program 

9 and a State basic health program under section 

10 1331 of the Patient Protection and Affordable Care 

11 Act (42 U.S.C. 18051). 

12 (4) An entity operating an Exchange. 

13 (5) A third-party data source, which may be a 

14 public or private entity. 

15 (c) PROCEDURES.—The Secretary of Health and 

16 Human Services, in consultation with the Secretary of the 

17 Treasury, shall establish procedures for the entities de18 scribed in subsection (b) to request a transfer of funding 

19 from the amounts appropriated under subsection (a), in20 cluding procedures for reviewing such requests, modifying 

21 and approving such requests, appealing decisions about 

22 transfers, and auditing such transfers. 


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1 SEC. 8. CONFORMING STATUTORY CHANGES. 

2 (a) STATE INCOME AND ELIGIBILITY VERIFICATION

3 SYSTEMS.—Section 1137 of the Social Security Act (42 

4 U.S.C. 1320b–7) is amended— 

5 (1) in subsection (a)(1), by inserting ‘‘(in the 

6 case of an individual who has consented to the dis7 closure and transfer of relevant return information 

8 that includes the individual’s social security account 

9 number pursuant to section 3(b)(1)(B) of the Easy 

10 Enrollment in Health Care Act, the State shall deem 

11 such individual to have satisfied the requirement to 

12 furnish such account number to the State under this 

13 paragraph)’’ before the semicolon; and 

14 (2) in subsection (d)— 

15 (A) in paragraph (1)(A), by striking ‘‘The 

16 State shall require’’ and inserting ‘‘Subject to 

17 paragraph (6), the State shall require’’; and 

18 (B) by adding at the end the following new 

19 paragraph: 

20 ‘‘(6) SATISFACTION OF REQUIREMENT

21 THROUGH RELIABLE DATA MATCHES.—In the case 

22 of an individual applying for the program described 

23 in paragraph (2) or the Children’s Health Insurance 

24 Program under title XXI of this Act, the program 

25 shall not require an individual to make the declara26 tion described in paragraph (1)(A) if the procedures 


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1 established pursuant to section 3(a)(1) of the Easy 

2 Enrollment in Health Care Act or section 

3 1413(c)(2)(B)(ii)(II) of the Patient Protection and 

4 Affordable Care Act (42 U.S.C. 

5 18083(c)(2)(B)(ii)(II)) were used to verify the indi6 vidual’s citizenship, based on the individual’s social 

7 security number as well as other identifying informa8 tion, which may include such facts as name and date 

9 of birth, that increases the accuracy of matches with 

10 applicable sources of citizenship data.’’. 

11 (b) ELIGIBILITY DETERMINATIONS UNDER

12 PPACA.—Section 1411(b) of the Patient Protection and 

13 Affordable Care Act (42 U.S.C. 18081(b)) is amended— 

14 (1) in paragraph (3), by striking subparagraph 

15 (A) and inserting the following: 

16 ‘‘(A) INFORMATION REGARDING INCOME

17 AND FAMILY SIZE.—The information described 

18 in paragraphs (21) and (23) of section 6103(l) 

19 of the Internal Revenue Code of 1986 for the 

20 applicable taxable year, as defined in section 

21 36B(c)(5) of such Code.’’; and 

22 (2) by adding at the end the following: 

23 ‘‘(6) RECEIPT OF INFORMATION.—The require24 ments for providing information under this sub25 section may be satisfied through data submitted to 


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1 the Exchange through reliable data matches, rather 

2 than by the applicant providing information. In the 

3 case described in paragraph (2)(A), data matches 

4 shall not be used for this purpose unless they meet 

5 the requirements described in section 1137(d)(6) of 

6 the Social Security Act (42 U.S.C. 1320b– 

7 7(d)(6)).’’. 

8 SEC. 9. ADVISORY COMMITTEE. 

9 (a) IN GENERAL.—The Secretary of the Treasury, in 

10 conjunction with the Secretary of Health and Human 

11 Services, shall establish an advisory committee to provide 

12 guidance to both Secretaries in carrying out this Act. The 

13 members of the committee shall include— 

14 (1) national experts in behavioral economics, 

15 other behavioral science, insurance affordability pro16 grams, enrollment and retention in health programs 

17 and other benefit programs, public benefits for im18 migrants, public benefits for other historically 

19 marginalized or disadvantaged communities, and 

20 Federal income tax policy and operations; and 

21 (2) representatives of all relevant stakeholders, 

22 including— 

23 (A) consumers; 

24 (B) health insurance issuers; 

25 (C) health care providers; and 


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1 (D) tax return preparers. 

2 (b) PURVIEW.—The advisory committee established 

3 under subsection (a) shall be solicited for advice on any 

4 topic chosen by the Secretary of the Treasury or the Sec5 retary of Health and Human Services, including (at a 

6 minimum) all matters as to which a provision in this Act, 

7 other than subsection (a), requires a consultation between 

8 the Secretary of the Treasury and the Secretary of Health 

9 and Human Services. 

10 SEC. 10. STUDY. 

11 (a) IN GENERAL.—The Secretary of Health and 

12 Human Services shall conduct a study analyzing the im13 pact of this Act and making recommendations for— 

14 (1) State pilot projects to test improvements to 

15 this Act, including an analysis of policies that auto16 matically enroll eligible individuals into group health 

17 plans; 

18 (2) modifying open enrollment periods for Ex19 changes and plan years so that open enrollment co20 incides with filing of Federal income tax returns; 

21 and 

22 (3) other steps to improve outcomes achieved by 

23 this Act. 

24 (b) REPORT.—Not later than July 1, 2028, the Sec25 retary of Health and Human Services shall deliver a reVerDate Sep 11 2014 03:36 Mar 10, 2023 Jkt 039200 PO 00000 Frm 00063 Fmt 6652 Sfmt 6201 E:\BILLS\H1113.IH H1113

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1 port on the study and recommendations under subsection 

2 (a) to the Committee on Ways and Means, the Committee 

3 on Education and the Workforce, and the Committee on 

4 Energy and Commerce of the House of Representatives 

5 and to the Committee on Finance and the Committee on 

6 Health, Education, Labor, and Pensions of the Senate. 

7 SEC. 11. APPROPRIATIONS. 

8 Out of amounts in the Treasury not otherwise appro9 priated, there are appropriated, in addition to the amounts 

10 described in section 7 and any amounts otherwise made 

11 available, to carry out the purposes of this Act, such sums 

12 as may be necessary to the Secretary of the Treasury, and 

13 such sums as may be necessary to the Secretary of Health 

14 and Human Services, to remain available until expended. 

Æ 


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