II 

118TH CONGRESS 

1ST SESSION S. 423 

To streamline enrollment in health insurance affordability programs and 

minimum essential coverage, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 14, 2023 

Mr. VAN HOLLEN introduced the following bill; which was read twice and 

referred to the Committee on Finance 

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: 

8 (1) CHIP PROGRAM.—The term ‘‘CHIP pro9 gram’’ means a State plan for child health assist10 ance under title XXI of the Social Security Act (42 


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

2 a plan. 

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

4 an American Health Benefit Exchange established 

5 under subtitle D of title I of the Patient Protection 

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

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

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

9 the Internal Revenue Code of 1986. 

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

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

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

13 1986. 

14 (5) HOUSEHOLD INCOME.—The term ‘‘house15 hold income’’ has the meaning given such term in 

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

17 1986. 

18 (6) HOUSEHOLD MEMBER.—The term ‘‘house19 hold member’’ means the taxpayer, the taxpayer’s 

20 spouse, and any dependent of the taxpayer. 

21 (7) INSURANCE AFFORDABILITY PROGRAM.— 

22 The term ‘‘insurance affordability program’’ means 

23 any of the following: 

24 (A) A Medicaid program. 

25 (B) A CHIP program. 


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1 (C) The program under title I of the Pa2 tient Protection and Affordable Care Act (42 

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

4 qualified health plans offered through an Ex5 change, including the premium tax credits 

6 under section 36B of the Internal Revenue 

7 Code of 1986, cost-sharing reductions under 

8 section 1402 of the Patient Protection and Af9 fordable Care Act (42 U.S.C. 18071), and the 

10 advance payment of such credits and reductions 

11 under section 1412(a)(3) of the Patient Protec12 tion and Affordable Care Act (42 U.S.C. 

13 18082(a)(3)). 

14 (D) A State basic health program under 

15 section 1331 of the Patient Protection and Af16 fordable Care Act (42 U.S.C. 18051). 

17 (E) Any other Federal, State, or local pro18 gram that provides assistance for some or all of 

19 the cost of minimum essential coverage and re20 quires eligibility for such program to be based 

21 in whole or in part on income, including such 

22 a program carried out through a waiver under 

23 section 1332 of the Patient Protection and Af24 fordable Care Act (42 U.S.C. 18052) or a State 

25 program supplementing the advanced payment 


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1 of tax credits and cost-sharing reductions under 

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

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

4 program’’ means a State plan for medical assistance 

5 under title XIX of the Social Security Act (42 

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

7 a plan. 

8 (9) MINIMUM ESSENTIAL COVERAGE.—The 

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

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

11 Revenue Code of 1986. 

12 (10) MODIFIED ADJUSTED GROSS INCOME.— 

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

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

15 the Internal Revenue Code of 1986. 

16 (11) NET PREMIUM.—The term ‘‘net pre17 mium’’, with respect to a health plan or other form 

18 of minimum essential coverage— 

19 (A) except as provided in subparagraph 

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

21 an individual required to enroll in such plan or 

22 coverage, after application of the premium tax 

23 credit under section 36B of the Internal Rev24 enue Code of 1986, the advance payment of 

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1 tient Protection and Affordable Care Act (42 

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

3 provided by an insurance affordability program; 

4 and 

5 (B) does not include any amounts de6 scribed in section 36B(b)(3)(D) of the Internal 

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

8 the Patient Protection and Affordable Care Act 

9 (42 U.S.C. 18023(b)(2)). 

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

11 has the meaning given such term in section 

12 36B(d)(3) of the Internal Revenue Code of 1986. 

13 (13) QUALIFIED HEALTH PLAN.—The term 

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

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

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

17 (14) RELEVANT RETURN INFORMATION.—The 

18 term ‘‘relevant return information’’ means, with re19 spect to a taxpayer, any return information, as de20 fined in section 6103(b)(2) of the Internal Revenue 

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

22 by the Secretary of the Treasury in consultation 

23 with the Secretary of Health and Human Services, 

24 with respect to— 


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1 (A) determining, or facilitating determina2 tion of, the eligibility of any household member 

3 of the taxpayer for any insurance affordability 

4 program, either directly or through enabling ac5 cess to additional information potentially rel6 evant to such eligibility; or 

7 (B) enrolling, or facilitating the enrollment 

8 of, such individual in minimum essential cov9 erage. 

10 (15) SINGLE, STREAMLINED APPLICATION.— 

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

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

13 Patient Protection and Affordable Care Act (42 

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

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

16 return preparer’’ has the meaning given such term 

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

18 of 1986. 

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

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

21 form of minimum essential coverage, means a net 

22 premium of $0.00 for such plan or coverage. 


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1 SEC. 3. FEDERAL INCOME TAX RETURNS USED TO FACILI2 TATE ENROLLMENT INTO INSURANCE AF3 FORDABILITY PROGRAMS. 

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

5 the Secretary shall establish a program which allows any 

6 taxpayer who is not covered under minimum essential cov7 erage at the time their return of tax for the taxable year 

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

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

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

11 begins after December 31, 2024, elect to— 

12 (1) have a determination made as to whether 

13 the household member who is not covered under 

14 such coverage is eligible for an insurance afford15 ability program; and 

16 (2) have such household member enrolled into 

17 minimum essential coverage, provided that— 

18 (A) such coverage is provided through a 

19 zero-net-premium plan, and 

20 (B) the taxpayer does not— 

21 (i) opt out of coverage through the 

22 zero-net-premium plan, or 

23 (ii) select a different plan. 

24 (b) TAXPAYER REQUIREMENTS AND CONSENT.— 

25 (1) IN GENERAL.—Pursuant to the program es26 tablished under subsection (a), the taxpayer may, in 


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1 conjunction with the filing of their return of tax for 

2 the taxable year— 

3 (A) identify any household member who is 

4 not covered under minimum essential coverage 

5 at the time of such filing; and 

6 (B) with respect to each household member 

7 identified under subparagraph (A), elect wheth8 er to— 

9 (i) in accordance with section 

10 6103(l)(23) of the Internal Revenue Code 

11 of 1986 (as added by subsection (f)), con12 sent to the disclosure and transfer to the 

13 applicable Exchange of any relevant return 

14 information for purposes of determining 

15 whether such household member may be el16 igible for any insurance affordability pro17 gram and facilitating enrollment into such 

18 program and minimum essential coverage, 

19 including any further disclosure and trans20 fer by the Exchange to any other entity as 

21 is deemed necessary to accomplish such 

22 purposes; and 

23 (ii) in the case consent is provided 

24 under clause (i) with respect to such 

25 household member, enroll such household 


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1 member in any minimum essential cov2 erage that is available with a zero net pre3 mium, if— 

4 (I) the member is eligible for 

5 such coverage through an insurance 

6 affordability program; and 

7 (II) the member does not, by the 

8 end of the special enrollment period 

9 described in section 4(c)(1)(A)— 

10 (aa) select a different plan 

11 offering minimum essential cov12 erage; or 

13 (bb) opt out of such cov14 erage that is available with a zero 

15 net premium. 

16 (2) ESTABLISHMENT OF OPTIONS FOR TAX17 PAYER CONSENT AND ELECTION.—For purposes of 

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

19 with the Secretary of Health and Human Services, 

20 may provide the elections under such paragraph as 

21 a single election or as 2 elections. 

22 (3) SUPPLEMENTAL FORM.— 

23 (A) IN GENERAL.—In the case of a tax24 payer who has consented to disclosure and 

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1 ant to paragraph (1)(B)(i), such taxpayer shall 

2 be enrolled in the insurance affordability pro3 gram only if the taxpayer submits a supple4 mental form which is designed to collect addi5 tional information necessary (as determined by 

6 the Secretary of Health and Human Services) 

7 to establish eligibility for and enrollment in an 

8 insurance affordability program, which may in9 clude (except as provided in subparagraph (B)), 

10 with respect to each individual described in 

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

12 (i) State of residence. 

13 (ii) Date of birth. 

14 (iii) Employment and the availability 

15 of benefits under a group health plan at 

16 the time the return of tax is filed. 

17 (iv) Any changed circumstances de18 scribed in section 1412(b)(2) of the Pa19 tient Protection and Affordable Care Act; 

20 (42 U.S.C. 18082(b)(2)). 

21 (v) Solely for the purpose of facili22 tating automatic renewal of coverage and 

23 eligibility redeterminations under section 

24 1413(c)(3)(A) of such Act (42 U.S.C. 

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1 retary to disclose relevant return informa2 tion for subsequent taxable years to insur3 ance affordability programs. 

4 (vi) Any methods preferred by the 

5 taxpayer or household member for the pur6 pose of being contacted by the applicable 

7 Exchange or insurance affordability pro8 gram with respect to any eligibility deter9 mination for, or enrollment in, an insur10 ance affordability program or minimum es11 sential coverage, such as an email address 

12 or a phone number for calls or text mes13 sages. 

14 (vii) Information about household 

15 composition that— 

16 (I) may affect eligibility for an 

17 insurance affordability program, and 

18 (II) is not otherwise included on 

19 the return of tax. 

20 (viii) Such other information as the 

21 Secretary, in consultation with the Sec22 retary of Health and Human Services, may 

23 require, including information requested on 

24 the single, streamlined application. 


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1 (B) LIMITATIONS.—The information ob2 tained through the form described in subpara3 graph (A) may not include any request for in4 formation with respect to citizenship, immigra5 tion status, or health status of any household 

6 member. 

7 (C) ADDITIONAL INFORMATION.—The 

8 form described in subparagraph (A) and the ac9 companying tax instructions may provide the 

10 taxpayer with additional information about in11 surance affordability programs, including infor12 mation provided to applicants on the single, 

13 streamlined application. 

14 (D) ACCESSIBILITY.— 

15 (i) IN GENERAL.—The Secretary shall 

16 ensure that the form described in subpara17 graph (A) is made available to all tax18 payers without discrimination based on 

19 language, disability, literacy, or internet 

20 access. 

21 (ii) RULE OF CONSTRUCTION.—Noth22 ing in clause (i) shall be construed as di23 minishing, reducing, or otherwise limiting 

24 any other legal obligation for the Secretary 

25 to avoid or to prevent discrimination. 


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

2 consultation with the Secretary of Health and 

3 Human Services, shall, with respect to any items de4 scribed in this subsection which are to be included 

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

6 such items which is as simple and clear as possible 

7 (such as referring to ‘‘insurance affordability pro8 grams’’ as ‘‘free or low-cost health insurance’’). 

9 (c) TAX RETURN PREPARERS.— 

10 (1) IN GENERAL.—With respect to any infor11 mation submitted in conjunction with a tax return 

12 solely for purposes of the program described in sub13 section (a), any tax return preparer involved in pre14 paring the return containing such information shall 

15 not be obligated to assess the accuracy of such infor16 mation as provided by the taxpayer. 

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

18 the program described in subsection (a), the Sec19 retary shall establish methods to allow for the imme20 diate transfer of any relevant return information to 

21 the applicable Exchange and insurance affordability 

22 programs in order to increase the potential for im23 mediate determinations of eligibility for and enroll24 ment in insurance affordability programs and min25 imum essential coverage. 


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1 (d) TRANSFER OF INFORMATION THROUGH SECURE

2 INTERFACE.— 

3 (1) IN GENERAL.—As part of the program es4 tablished under subsection (a), the Secretary shall 

5 develop a secure, electronic interface allowing an ex6 change of relevant return information with the appli7 cable Exchange in a manner similar to the interface 

8 described in section 1413(c)(1) of the Patient Pro9 tection and Affordable Care Act (42 U.S.C. 

10 18083(c)(1)). Upon receipt of such information, the 

11 applicable Exchange may convey such information to 

12 any other entity as needed to facilitate determina13 tion of eligibility for an insurance affordability pro14 gram or enrollment into minimum essential cov15 erage. 

16 (2) TRANSFER BY TREASURY OR TAX PRE17 PARERS.— 

18 (A) IN GENERAL.—The interface described 

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

20 who has provided consent pursuant to sub21 section (b)(1)(B)(i), for relevant return infor22 mation, along with confirmation that the Sec23 retary has accepted the return filing as meeting 

24 applicable processing criteria, to be transferred 

25 to an applicable Exchange by— 


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1 (i) the Secretary; or 

2 (ii) pursuant to such requirements 

3 and standards as are established by the 

4 Secretary (in consultation with the Sec5 retary of Health and Human Services)— 

6 (I) if the Secretary is not able to 

7 transfer such information to the appli8 cable Exchange, the taxpayer; or 

9 (II) the tax return preparer who 

10 prepared the return containing such 

11 information. 

12 (B) TRANSFER REQUIREMENTS.—As soon 

13 as is practicable after the filing of a return de14 scribed in subsection (a) in which the taxpayer 

15 has provided consent pursuant to subsection 

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

17 relevant return information to be transferred to 

18 the applicable Exchange. 

19 (C) DATA SECURITY.—Any transfer of rel20 evant return information described in this sub21 section shall be conducted— 

22 (i) pursuant to interagency agree23 ments that ensure data security and main24 tain privacy in a manner that satisfies the 

25 requirements under section 1942(b) of the 


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

2 2(b)); and 

3 (ii) in the case of any taxpayer filing 

4 their tax return electronically, in a manner 

5 that maximizes the opportunity for such 

6 taxpayer, as part of the process of filing 

7 such return, to immediately— 

8 (I) obtain a determination with 

9 respect to the eligibility of any house10 hold member for any insurance af11 fordability program; and 

12 (II) enroll in minimum essential 

13 coverage. 

14 (e) ERRORS THAT AFFECT ELIGIBILITY FOR INSUR15 ANCE AFFORDABILITY PROGRAMS.—The Secretary of 

16 Health and Human Services, in consultation with the Sec17 retary, shall establish procedures for addressing instances 

18 in which an error in relevant return information that was 

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

20 resulted in a determination that an individual is eligible 

21 for more or less assistance under an insurance afford22 ability program than the assistance for which the indi23 vidual would otherwise have been eligible without the 

24 error. Such procedures shall include procedures for— 


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

2 the Secretary of Health and Human Services, and 

3 the applicable Exchange and insurance affordability 

4 program, regardless of whether such error was in5 cluded in an amendment to the tax return; and 

6 (2) correcting, as soon as practicable, the indi7 vidual’s eligibility status for insurance affordability 

8 programs, subject to, in the case of reduced eligi9 bility for assistance, any right of notice and appeal 

10 under laws governing the applicable insurance af11 fordability program, including section 1411(f) of the 

12 Patient Protection and Affordable Care Act (42 

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

14 (f) DISCLOSURE OF RETURN INFORMATION FOR DE15 TERMINING ELIGIBILITY FOR INSURANCE AFFORD16 ABILITY PROGRAMS AND ENROLLMENT INTO MINIMUM

17 ESSENTIAL HEALTH COVERAGE.— 

18 (1) IN GENERAL.—Section 6103(l) of the Inter19 nal Revenue Code of 1986 is amended by adding at 

20 the end the following: 

21 ‘‘(23) DISCLOSURE OF RETURN INFORMATION

22 FOR DETERMINING ELIGIBILITY FOR INSURANCE AF23 FORDABILITY PROGRAMS AND ENROLLMENT INTO

24 MINIMUM ESSENTIAL HEALTH COVERAGE.— 


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

2 taxpayer who has consented to the disclosure 

3 and transfer of any relevant return information 

4 with respect to any household member pursuant 

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

6 Health Care Act, the Secretary shall disclose 

7 such information to the applicable Exchange. 

8 ‘‘(B) RESTRICTION ON DISCLOSURE.—Re9 turn information disclosed under subparagraph 

10 (A) may be— 

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

12 purposes of, and to the extent necessary 

13 in— 

14 ‘‘(I) determining eligibility for an 

15 insurance affordability program, or 

16 ‘‘(II) facilitating enrollment into 

17 minimum essential coverage, and 

18 ‘‘(ii) further disclosed by an Exchange 

19 to any other person only for the purposes 

20 of, and to the extent necessary, to carry 

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

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

23 paragraph, the terms ‘relevant return informa24 tion’, ‘Exchange’, ‘insurance affordability pro25 gram’, and ‘minimum essential coverage’ have 


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1 the same meanings given such terms under sec2 tion 2 of the Easy Enrollment in Health Care 

3 Act.’’. 

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

5 Internal Revenue Code of 1986 is amended by in6 serting ‘‘or any Exchange described in subsection 

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

8 (l)(21),’’ each place it appears. 

9 (g) APPLICATIONS FOR INSURANCE AFFORDABILITY

10 PROGRAMS WITHOUT RELIANCE ON FEDERAL INCOME

11 TAX RETURNS.— 

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

13 Act shall be construed as requiring any individual, 

14 as a condition of applying for an insurance afford15 ability program, to— 

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

17 year for which filing a return of tax would not 

18 otherwise be required for such taxable year; or 

19 (B) consent to disclosure of relevant return 

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

21 (2) METHODS AND PROCEDURES.—Any agency 

22 administering an insurance affordability program 

23 shall implement methods and procedures, as pre24 scribed by the Secretary of Health and Human Serv25 ices, in consultation with the Secretary, through 


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

2 insurance affordability program without filing a re3 turn of tax or consenting to disclosure of relevant 

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

5 the program determines household income and fam6 ily size for— 

7 (A) a calendar year described in section 

8 1902(e)(14)(D)(vii)(I) of the Social Security 

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

10 5(a); and 

11 (B) an applicable taxable year, as defined 

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

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

14 (h) SECRETARY.—In this section, the term ‘‘Sec15 retary’’ means the Secretary of the Treasury, or the Sec16 retary’s delegate. 

17 SEC. 4. EXCHANGE USE OF RELEVANT RETURN INFORMA18 TION. 

19 (a) IN GENERAL.—An Exchange that receives rel20 evant return information under section 3(d) with respect 

21 to a taxpayer who has provided consent under section 

22 3(b)(1)(B) shall— 

23 (1) minimize additional information (if any) 

24 that is required to be provided by such taxpayer for 

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1 fordability program by, whenever feasible, qualifying 

2 such household member for such program based 

3 on— 

4 (A) relevant information provided on the 

5 tax return filed by the taxpayer, including in6 formation on the supplemental form described 

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

8 (B) information from other reliable third9 party data sources that is relevant to eligibility 

10 for such program but not available from the re11 turn, including information obtained through 

12 data matching based on social security num13 bers, other identifying information, and other 

14 items obtained from such return; 

15 (2) determine the eligibility of any household 

16 member for the CHIP program and, where eligibility 

17 is determined based on modified adjusted gross in18 come, the Medicaid program, as required under sec19 tion 1413 of the Patient Protection and Affordable 

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

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

22 any right of notice and appeal under laws governing 

23 such programs, including section 1411(f) of the Pa24 tient Protection and Affordable Care Act (42 U.S.C. 

25 18081(f)); 


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1 (3) to the extent that any additional informa2 tion is necessary for determining the eligibility of 

3 any household member for an insurance affordability 

4 program, obtain such information in the manner 

5 that— 

6 (A) imposes the lowest feasible procedural 

7 burden to the taxpayer, including— 

8 (i) in the case of a taxpayer filing 

9 their tax return electronically, online col10 lection of such information at or near the 

11 time of such filing; and 

12 (ii) prior to a denial of eligibility or 

13 enrollment due to failure to provide such 

14 information, attempting to contact the tax15 payer multiple times using the preferred 

16 contact methods described in section 

17 3(b)(3)(A)(vi); and 

18 (B) provides the individual with all proce19 dural protections that would otherwise be avail20 able in applying for such program, including 

21 the reasonable opportunity period described in 

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

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


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

2 insurance affordability program other than the Med3 icaid program— 

4 (A) enable such individual, through proce5 dures prescribed by the Secretary of Health and 

6 Human Services, to seek coverage under the 

7 Medicaid program or CHIP program by pro8 viding additional information demonstrating po9 tential eligibility for such program, with any re10 sulting determination subject to rights of notice 

11 and appeal under laws governing insurance af12 fordability programs, including section 1411(f) 

13 of the Patient Protection and Affordable Care 

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

15 (B) provide such individual with notice of 

16 such procedures. 

17 (b) MEDICAID AND CHIP.— 

18 (1) STATE OPTIONS.— 

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

20 the Secretary of Health and Human Services is 

21 determining eligibility for individuals who apply 

22 for insurance affordability programs at the Ex23 change serving residents of the individual’s 

24 State, the Secretary of Health and Human 

25 Services shall present the State with not less 


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1 than 3 sets of options for verification proce2 dures and business rules that the Exchange 

3 serving residents of such State shall use in de4 termining eligibility for the State Medicaid pro5 gram and CHIP program with respect to indi6 viduals who are household members described 

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

8 other provision of law, the Secretary of Health 

9 and Human Services may present each State 

10 with the same 3 sets of options, provided that 

11 each set can be customized to reflect each 

12 State’s decisions about optional eligibility cat13 egories and criteria for the Medicaid program 

14 and CHIP program. 

15 (B) BUSINESS RULES.—The business rules 

16 described in subparagraph (A) shall specify de17 tailed eligibility determination rules and proce18 dures for processing initial applications and re19 newals, including— 

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

21 State agencies and other sources described 

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

23 of the Patient Protection and Affordable 

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


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1 (ii) the circumstances for administra2 tive renewal of eligibility for the Medicaid 

3 program and the CHIP program, based on 

4 data showing probable continued eligibility. 

5 (C) DEFAULT.—In the case of a State de6 scribed in subparagraph (A) that does not se7 lect an option from the set presented under 

8 such subparagraph within a timeframe specified 

9 by the Secretary of Health and Human Serv10 ices, the Secretary of Health and Human Serv11 ices shall determine the option that the Ex12 change shall use for such State for the purposes 

13 described in such subparagraph. 

14 (D) RULE OF CONSTRUCTION.—Nothing in 

15 this paragraph shall be construed as requiring 

16 a State to provide benefits under title XIX or 

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

18 et seq., 1397aa et seq.) to a category of individ19 uals, or to set an income eligibility threshold for 

20 benefits under such titles at a certain level, if 

21 the State is not otherwise required to do so 

22 under such titles. 

23 (2) ENROLLMENT.— 

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

25 State determines that an individual described in 


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26 

•S 423 IS

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

2 the State Medicaid program or CHIP program, 

3 the Exchange shall send the relevant informa4 tion about the individual to the State and, if 

5 consent has been given under section 

6 3(b)(1)(B) to enrollment in a health plan or 

7 other form of minimum essential coverage with 

8 a zero net premium, the State shall enroll such 

9 individual in the State Medicaid program or 

10 CHIP program (as applicable) as soon as prac11 ticable, except as provided in subparagraphs 

12 (B) and (D). 

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

14 an individual in coverage under the State Med15 icaid program or CHIP program without the af16 firmative consent of the individual if the indi17 vidual would be required to pay a premium for 

18 such coverage. 

19 (C) MANAGED CARE.—If the State Med20 icaid program or CHIP program requires an in21 dividual enrolled under subparagraph (A) to re22 ceive coverage through a managed care organi23 zation or entity, the State shall use a procedure 

24 for assigning the individual to such an organi25 zation or entity (including auto-assignment proVerDate Sep 11 2014 04:58 Mar 02, 2023 Jkt 039200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\S423.IS S423

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•S 423 IS

1 cedures) that is commonly used in the State 

2 when an individual who is found eligible for 

3 such program does not affirmatively select a 

4 particular organization or entity. 

5 (D) OPT-OUT PROCEDURES.—Notwith6 standing subparagraph (A), an individual de7 scribed in such subparagraph shall be given one 

8 or more opportunities to opt out of coverage 

9 under a State Medicaid program or CHIP pro10 gram, using procedures prescribed by the Sec11 retary of Health and Human Services. 

12 (c) ADVANCE PREMIUM TAX CREDITS FOR QUALI13 FIED HEALTH PLANS.— 

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

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

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

17 the Internal Revenue Code of 1986 with respect to 

18 such year and has provided consent described in sec19 tion 3(b)(1)(B)(i), if the Exchange has determined 

20 that an applicable household member has not quali21 fied for the Medicaid program or the CHIP pro22 gram, such Exchange shall— 

23 (A) in addition to any such period that 

24 may otherwise be available, provide a special 


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•S 423 IS

1 enrollment period that begins on the date the 

2 taxpayer has provided such consent; and 

3 (B) determine— 

4 (i) whether the taxpayer would, pursu5 ant to section 1412 of the Patient Protec6 tion and Affordable Care Act (42 U.S.C. 

7 18082), be eligible for advance payment of 

8 the premium assistance tax credit under 

9 section 36B of the Internal Revenue Code 

10 of 1986 if such household member of the 

11 taxpayer were enrolled in a qualified health 

12 plan; and 

13 (ii) if the taxpayer has made the elec14 tion described in section 3(b)(1)(B)(ii), 

15 whether such household member has one 

16 or more options to enroll in a qualified 

17 health plan with a zero net premium. 

18 (2) ENROLLMENT IN A QUALIFIED HEALTH

19 PLAN WITH A ZERO NET PREMIUM.— 

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

21 household member described in paragraph (1) 

22 has one or more options to enroll in a qualified 

23 health plan with a zero net premium, and con24 sent has been given under section 3(b)(1)(B) 


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•S 423 IS

1 for enrollment of such household member in a 

2 qualified health plan with a zero net premium— 

3 (i) the Exchange shall identify a set of 

4 options (as described in subparagraph (B)) 

5 for qualified health plans offering a zero 

6 net premium; and 

7 (ii) from such set, select a qualified 

8 health plan as the default enrollment 

9 choice for the household member in accord10 ance with subparagraph (C). 

11 (B) OPTION SETS.— 

12 (i) IN GENERAL.—In the case that 

13 multiple qualified health plans with a zero 

14 net premium are available with more than 

15 1 actuarial value, the Exchange shall limit 

16 the set of options under subparagraph 

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

18 the highest available actuarial value. 

19 (ii) FURTHER RESTRICTIONS.—In the 

20 case described in clause (i), the Exchange 

21 may further limit the set of options under 

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

23 health plans that have the highest available 

24 actuarial value as described in clause (i), 

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•S 423 IS

1 erage of services not subject to a deduct2 ible. 

3 (iii) DEFINITION OF HIGHEST ACTU4 ARIAL VALUE.—For purposes of this sub5 paragraph, the term ‘‘highest actuarial 

6 value’’ means the highest actuarial value 

7 among— 

8 (I) the levels of coverage de9 scribed in paragraph (1) of section 

10 1302(d) of the Patient Protection and 

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

12 18022(d)), without regard to allow13 able variance under paragraph (3) of 

14 such section; and 

15 (II) as applicable, the levels of 

16 coverage that result from the applica17 tion of cost-sharing reductions under 

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

19 18071). 

20 (C) SELECTING A DEFAULT OPTION.—The 

21 Secretary of Health and Human Services shall 

22 establish procedures that Exchanges may use in 

23 selecting, from the set of options described in 

24 subparagraph (B), the default enrollment choice 


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•S 423 IS

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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•S 423 IS

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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•S 423 IS

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 04:58 Mar 02, 2023 Jkt 039200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\S423.IS S423

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•S 423 IS

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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•S 423 IS

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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•S 423 IS

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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•S 423 IS

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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•S 423 IS

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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•S 423 IS

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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•S 423 IS

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 04:58 Mar 02, 2023 Jkt 039200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\S423.IS S423

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•S 423 IS

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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•S 423 IS

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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•S 423 IS

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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•S 423 IS

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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•S 423 IS

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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•S 423 IS

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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•S 423 IS

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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•S 423 IS

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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•S 423 IS

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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•S 423 IS

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 04:58 Mar 02, 2023 Jkt 039200 PO 00000 Frm 00050 Fmt 6652 Sfmt 6201 E:\BILLS\S423.IS S423

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•S 423 IS

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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•S 423 IS

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 subsection (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 04:58 Mar 02, 2023 Jkt 039200 PO 00000 Frm 00063 Fmt 6652 Sfmt 6201 E:\BILLS\S423.IS S423

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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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