scribed by the Secretary of Health and Human Serv-
ices, in consultation with the Secretary, through 
which, in the case of an individual applying for an 
insurance affordability program without filing a re-
turn of tax or consenting to disclosure of relevant 
return information under subsection (b)(1)(B)(i), 
the program determines household income and fam-
ily size for— 
(A) a calendar year described in section 
1902(e)(14)(D)(vii)(I) of the Social Security 
Act (42 U.S.C. 1396a), as added by section 
5(a); and 
(B) an applicable taxable year, as defined 
in section 36B(c)(5) of the Internal Revenue 
Code of 1986 (as added by section 5(b)). 
(h) SECRETARY.—In this section, the term ‘‘Sec-
retary’’ means the Secretary of the Treasury, or the Sec-
retary’s delegate. 
SEC. 4. EXCHANGE USE OF RELEVANT RETURN INFORMA-
TION. 
(a) IN GENERAL.—An Exchange that receives rel-
evant return information under section 3(d) with respect 
to a taxpayer who has provided consent under section 
3(b)(1)(B) shall— 
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(1) minimize additional information (if any) 
that is required to be provided by such taxpayer for 
a household member to qualify for any insurance af-
fordability program by, whenever feasible, qualifying 
such household member for such program based 
on— 
(A) relevant information provided on the 
tax return filed by the taxpayer, including in-
formation on the supplemental form described 
in section 3(b)(3); and 
(B) information from other reliable third- 
party data sources that is relevant to eligibility 
for such program but not available from the re-
turn, including information obtained through 
data matching based on social security num-
bers, other identifying information, and other 
items obtained from such return; 
(2) determine the eligibility of any household 
member for the CHIP program and, where eligibility 
is determined based on modified adjusted gross in-
come, the Medicaid program, as required under sec-
tion 1413 of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18083) and section 1943 of the 
Social Security Act (42 U.S.C. 1396w–3), subject to 
any right of notice and appeal under laws governing 
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such programs, including section 1411(f) of the Pa-
tient Protection and Affordable Care Act (42 U.S.C. 
18081(f)); 
(3) to the extent that any additional informa-
tion is necessary for determining the eligibility of 
any household member for an insurance affordability 
program, obtain such information in the manner 
that— 
(A) imposes the lowest feasible procedural 
burden to the taxpayer, including— 
(i) in the case of a taxpayer filing 
their tax return electronically, online col-
lection of such information at or near the 
time of such filing; and 
(ii) prior to a denial of eligibility or 
enrollment due to failure to provide such 
information, attempting to contact the tax-
payer multiple times using the preferred 
contact methods described in section 
3(b)(3)(A)(vi); and 
(B) provides the individual with all proce-
dural protections that would otherwise be avail-
able in applying for such program, including 
the reasonable opportunity period described in 
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section 1137(d)(4)(A) of the Social Security 
Act (42U.S.C. 1320b–7(d)(4)(A)); and 
(4) when an individual is found eligible for an 
insurance affordability program other than the Med-
icaid program— 
(A) enable such individual, through proce-
dures prescribed by the Secretary of Health and 
Human Services, to seek coverage under the 
Medicaid program or CHIP program by pro-
viding additional information demonstrating po-
tential eligibility for such program, with any re-
sulting determination subject to rights of notice 
and appeal under laws governing insurance af-
fordability programs, including section 1411(f) 
of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18081(f)); and 
(B) provide such individual with notice of 
such procedures. 
(b) MEDICAID AND CHIP.— 
(1) STATE OPTIONS.— 
(A) IN GENERAL.—In a State for which 
the Secretary of Health and Human Services is 
determining eligibility for individuals who apply 
for insurance affordability programs at the Ex-
change serving residents of the individual’s 
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State, the Secretary of Health and Human 
Services shall present the State with not less 
than 3 sets of options for verification proce-
dures and business rules that the Exchange 
serving residents of such State shall use in de-
termining eligibility for the State Medicaid pro-
gram and CHIP program with respect to indi-
viduals who are household members described 
in section 3(b)(1)(B). Notwithstanding any 
other provision of law, the Secretary of Health 
and Human Services may present each State 
with the same 3 sets of options, provided that 
each set can be customized to reflect each 
State’s decisions about optional eligibility cat-
egories and criteria for the Medicaid program 
and CHIP program. 
(B) BUSINESS RULES.—The business rules 
described in subparagraph (A) shall specify de-
tailed eligibility determination rules and proce-
dures for processing initial applications and re-
newals, including— 
(i) the Secretary’s use of data from 
State agencies and other sources described 
in subsection (c)(3)(A)(ii) of section 1413 
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