I 
117TH CONGRESS 
1ST SESSION H. R. 5610 
To streamline enrollment in health insurance affordability programs and 
minimum essential coverage, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 19, 2021 
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 juris-
diction of the committee concerned 
A BILL 
To streamline enrollment in health insurance affordability 
programs and minimum essential coverage, and for other 
purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Easy Enrollment in 
Health Care Act’’. 
SEC. 2. DEFINITIONS. 
In this Act: 
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(1) CHIP PROGRAM.—The term ‘‘CHIP pro-
gram’’ means a State plan for child health assist-
ance under title XXI of the Social Security Act (42 
U.S.C. 1397aa et seq.), including any waiver of such 
a plan. 
(2) EXCHANGE.—The term ‘‘Exchange’’ means 
an American Health Benefit Exchange established 
under subtitle D of title I of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18021 et seq.). 
(3) GROUP HEALTH PLAN.—The term ‘‘group 
health plan’’ has the meaning given such term in 
section 5000(b)(1) of the Internal Revenue Code of 
1986. 
(4) HOUSEHOLD INCOME.—The term ‘‘house-
hold income’’ has the meaning given such term in 
section 36B(d) of the Internal Revenue Code of 
1986. 
(5) HOUSEHOLD MEMBER.—The term ‘‘house-
hold member’’ means the taxpayer, the taxpayer’s 
spouse, and any dependent of the taxpayer. 
(6) FAMILY SIZE.—The term ‘‘family size’’ has 
the meaning given such term in section 36B(d) of 
the Internal Revenue Code of 1986. 
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(7) INSURANCE
AFFORDABILITY
PROGRAM.— 
The term ‘‘insurance affordability program’’ means 
any of the following: 
(A) A Medicaid program. 
(B) A CHIP program. 
(C) The program under title I of the Pa-
tient Protection and Affordable Care Act (42 
U.S.C. 18001 et seq.) for the enrollment in 
qualified health plans offered through an Ex-
change, including the premium tax credits 
under section 36B of the Internal Revenue 
Code of 1986, cost-sharing reductions under 
section 1402 of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18071), and the 
advance payment of such credits and reductions 
under section 1412(a)(3) of the Patient Protec-
tion and Affordable Care Act (42 U.S.C. 
18082(a)(3)). 
(D) A State basic health program under 
section 1331 of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18051). 
(E) Any other Federal, State, or local pro-
gram that provides assistance for some or all of 
the cost of minimum essential coverage and re-
quires eligibility for such program to be based 
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in whole or in part on income, including such 
a program carried out through a waiver under 
section 1332 of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18052) or a State 
program supplementing the advanced payment 
of tax credits and cost-sharing reductions under 
section 1412(a)(3) of such Act. 
(8) MEDICAID PROGRAM.—The term ‘‘Medicaid 
program’’ means a State plan for medical assistance 
under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.), including any waiver of such 
a plan. 
(9) MINIMUM
ESSENTIAL
COVERAGE.—The 
term ‘‘minimum essential coverage’’ has the meaning 
given such term in section 5000A(f) of the Internal 
Revenue Code of 1986. 
(10) MODIFIED
ADJUSTED
GROSS
INCOME.— 
The term ‘‘modified adjusted gross income’’ has the 
meaning given such term in section 36B(d)(2)(B) of 
the Internal Revenue Code of 1986. 
(11) NET
PREMIUM.—The term ‘‘net pre-
mium’’, with respect to a health plan or other form 
of minimum essential coverage— 
(A) except as provided in subparagraph 
(B), means the payment from or on behalf of 
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an individual required to enroll in such plan or 
coverage, after application of the premium tax 
credit under section 36B of the Internal Rev-
enue Code of 1986, the advance payment of 
such credit under section 1412(a)(3) of the Pa-
tient Protection and Affordable Care Act (42 
U.S.C. 18082(a)(3)), and any other assistance 
provided by an insurance affordability program; 
and 
(B) does not include any amounts de-
scribed in section 36B(b)(3)(D) of the Internal 
Revenue Code of 1986 or section 1303(b)(2) of 
the Patient Protection and Affordable Care Act 
(42 U.S.C. 18023(b)(2)). 
(12) POVERTY LINE.—The term ‘‘poverty line’’ 
has the meaning given such term in section 
36B(d)(3) of the Internal Revenue Code of 1986. 
(13) QUALIFIED
HEALTH
PLAN.—The term 
‘‘qualified health plan’’ has the meaning given such 
term in section 1301(a) of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18021(a)). 
(14) RELEVANT RETURN INFORMATION.—The 
term ‘‘relevant return information’’ means, with re-
spect to a taxpayer, any return information, as de-
fined in section 6103(b)(2) of the Internal Revenue 
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Code of 1986, which may be relevant, as determined 
by the Secretary of the Treasury in consultation 
with the Secretary of Health and Human Services, 
with respect to— 
(A) determining, or facilitating determina-
tion of, the eligibility of any household member 
of the taxpayer for any insurance affordability 
program, either directly or through enabling ac-
cess to additional information potentially rel-
evant to such eligibility; or 
(B) enrolling, or facilitating the enrollment 
of, such individual in minimum essential cov-
erage. 
(15) SINGLE, STREAMLINED
APPLICATION.— 
The term ‘‘single, streamlined application’’ means 
the form described in section 1413(b)(1)(A) of the 
Patient Protection and Affordable Care Act (42 
U.S.C. 18083(b)(1)(A)). 
(16) TAX RETURN PREPARER.—The term ‘‘tax 
return preparer’’ has the meaning given such term 
in section 7701(a)(36) of the Internal Revenue Code 
of 1986. 
(17) ZERO NET PREMIUM.—The term ‘‘zero net 
premium’’, with respect to a health plan or other 
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form of minimum essential coverage, means a net 
premium of $0.00 for such plan coverage. 
SEC. 3. FEDERAL INCOME TAX RETURNS USED TO FACILI-
TATE ENROLLMENT INTO INSURANCE AF-
FORDABILITY PROGRAMS. 
(a) IN GENERAL.—Not later than January 1, 2024, 
the Secretary shall establish a program which allows any 
taxpayer who is not covered under minimum essential cov-
erage at the time their return of tax for the taxable year 
is filed, as well as any other household member who is 
not covered under such coverage, to, in conjunction with 
the filing of their return of tax for any taxable year which 
begins after December 31, 2022, elect to— 
(1) have a determination made as to whether 
the household member who is not covered under 
such coverage is eligible for an insurance afford-
ability program; and 
(2) have such household member enrolled into 
minimum essential coverage, provided that— 
(A) such coverage is provided through a 
zero-net-premium plan, and 
(B) the taxpayer does not— 
(i) opt out of coverage through the 
zero-net-premium plan, or 
(ii) select a different plan. 
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(b) TAXPAYER REQUIREMENTS AND CONSENT.— 
(1) IN GENERAL.—Pursuant to the program es-
tablished under subsection (a), the taxpayer may, in 
conjunction with the filing of their return of tax for 
the taxable year— 
(A) identify any household member who is 
not covered under minimum essential coverage 
at the time of such filing; and 
(B) with respect to each household member 
identified under subparagraph (A), elect wheth-
er to— 
(i) 
in 
accordance 
with 
section 
6103(l)(23) of the Internal Revenue Code 
of 1986 (as added by subsection (f)), con-
sent to the disclosure and transfer to the 
applicable Exchange of any relevant return 
information for purposes of determining 
whether such household member may be el-
igible for any insurance affordability pro-
gram and facilitating enrollment into such 
program and minimum essential coverage, 
including any further disclosure and trans-
fer by the Exchange to any other entity as 
is deemed necessary to accomplish such 
purposes; and 
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(ii) in the case consent is provided 
under clause (i) with respect to such 
household member, enroll such household 
member in any minimum essential cov-
erage that is available with a zero net pre-
mium, if— 
(I) the member is eligible for 
such coverage through an insurance 
affordability program; and 
(II) the member does not, by the 
end of the special enrollment period 
described in section 4(c)(1)(A)— 
(aa) select a different plan 
offering minimum essential cov-
erage; or 
(bb) opt out of such cov-
erage that is available with a zero 
net premium. 
(2) ESTABLISHMENT
OF
OPTIONS
FOR
TAX-
PAYER CONSENT AND ELECTION.—For purposes of 
paragraph (1)(B), the Secretary, in consultation 
with the Secretary of Health and Human Services, 
may provide the elections under such paragraph as 
a single election or as 2 elections. 
(3) SUPPLEMENTAL FORM.— 
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(A) IN GENERAL.—In the case of a tax-
payer who has consented to disclosure and 
transfer of relevant return information pursu-
ant to paragraph (1)(B)(i), such taxpayer shall 
be enrolled in the insurance affordability pro-
gram only if the taxpayer submits a supple-
mental form which is designed to collect addi-
tional information necessary (as determined by 
the Secretary of Health and Human Services) 
to establish eligibility for and enrollment in an 
insurance affordability program, which may in-
clude (except as provided in subparagraph (B)), 
with respect to each individual described in 
paragraph (1)(A), the following: 
(i) State of residence. 
(ii) Date of birth. 
(iii) Employment and the availability 
of benefits under a group health plan at 
the time the return of tax is filed. 
(iv) Any changed circumstances de-
scribed in section 1412(b)(2) of the Pa-
tient Protection and Affordable Care Act; 
(42 U.S.C. 18082(b)(2)). 
(v) Solely for the purpose of facili-
tating automatic renewal of coverage and 
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eligibility redeterminations under section 
1413(c)(3)(A) of such Act (42 U.S.C. 
18083(c)(3)(A)), authorization for the Sec-
retary to disclose relevant return informa-
tion for subsequent taxable years to insur-
ance affordability programs. 
(vi) Any methods preferred by the 
taxpayer or household member for the pur-
pose of being contacted by the applicable 
Exchange or insurance affordability pro-
gram with respect to any eligibility deter-
mination for, or enrollment in, an insur-
ance affordability program or minimum es-
sential coverage, such as an email address 
or a phone number for calls or text mes-
sages. 
(vii) Information about household 
composition that— 
(I) may affect eligibility for an 
insurance affordability program, and 
(II) is not otherwise included on 
the return of tax. 
(viii) Such other information as the 
Secretary, in consultation with the Sec-
retary of Health and Human Services, may 
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require, including information requested on 
the single, streamlined application. 
(B) LIMITATIONS.—The information ob-
tained through the form described in subpara-
graph (A) may not include any request for in-
formation with respect to citizenship, immigra-
tion status, or health status of any household 
member. 
(C) 
ADDITIONAL
INFORMATION.—The 
form described in subparagraph (A) and the ac-
companying tax instructions may provide the 
taxpayer with additional information about in-
surance affordability programs, including infor-
mation provided to applicants on the single, 
streamlined application. 
(D) ACCESSIBILITY.— 
(i) IN GENERAL.—The Secretary shall 
ensure that the form described in subpara-
graph (A) is made available to all tax-
payers without discrimination based on 
language, disability, literacy, or internet 
access. 
(ii) RULE OF CONSTRUCTION.—Noth-
ing in clause (i) shall be construed as di-
minishing, reducing, or otherwise limiting 
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any other legal obligation for the Secretary 
to avoid or to prevent discrimination. 
(4) RETURN
LANGUAGE.—The Secretary, in 
consultation with the Secretary of Health and 
Human Services, shall, with respect to any items de-
scribed in this subsection which are to be included 
in a taxpayer’s return of tax, develop language for 
such items which is as simple and clear as possible 
(such as referring to ‘‘insurance affordability pro-
grams’’ as ‘‘free or low-cost health insurance’’). 
(c) TAX RETURN PREPARERS.— 
(1) IN GENERAL.—With respect to any infor-
mation submitted in conjunction with a tax return 
solely for purposes of the program described in sub-
section (a), any tax return preparer involved in pre-
paring the return containing such information shall 
not be obligated to assess the accuracy of such infor-
mation as provided by the taxpayer. 
(2) SUBMISSION OF INFORMATION.—As part of 
the program described in subsection (a), the Sec-
retary shall establish methods to allow for the imme-
diate transfer of any relevant return information to 
the applicable Exchange and insurance affordability 
programs in order to increase the potential for im-
mediate determinations of eligibility for and enroll-
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ment in insurance affordability programs and min-
imum essential coverage. 
(d) TRANSFER OF INFORMATION THROUGH SECURE 
INTERFACE.— 
(1) IN GENERAL.—As part of the program es-
tablished under subsection (a), the Secretary shall 
develop a secure, electronic interface allowing an ex-
change of relevant return information with the appli-
cable Exchange in a manner similar to the interface 
described in section 1413(c)(1) of the Patient Pro-
tection and Affordable Care Act (42 U.S.C. 
18083(c)(1)). Upon receipt of such information, the 
applicable Exchange may convey such information to 
any other entity as needed to facilitate determina-
tion of eligibility for an insurance affordability pro-
gram or enrollment into minimum essential cov-
erage. 
(2) TRANSFER
BY
TREASURY
OR
TAX
PRE-
PARERS.— 
(A) IN GENERAL.—The interface described 
in paragraph (1) shall allow, for any taxpayer 
who has provided consent pursuant to sub-
section (b)(1)(B)(i), for relevant return infor-
mation, along with confirmation that the Sec-
retary has accepted the return filing as meeting 
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applicable processing criteria, to be transferred 
to an applicable Exchange by— 
(i) the Secretary; or 
(ii) pursuant to such requirements 
and standards as are established by the 
Secretary (in consultation with the Sec-
retary of Health and Human Services)— 
(I) if the Secretary is not able to 
transfer such information to the appli-
cable Exchange, the taxpayer; or 
(II) the tax return preparer who 
prepared the return containing such 
information. 
(B) TRANSFER REQUIREMENTS.—As soon 
as is practicable after the filing of a return de-
scribed in subsection (a) in which the taxpayer 
has provided consent pursuant to subsection 
(b)(1)(B)(i), the Secretary shall provide for all 
relevant return information to be transferred to 
the applicable Exchange. 
(C) DATA SECURITY.—Any transfer of rel-
evant return information described in this sub-
section shall be conducted— 
(i) pursuant to interagency agree-
ments that ensure data security and main-
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tain privacy in a manner that satisfies the 
requirements under section 1942(b) of the 
Social Security Act (42 U.S.C. 1396w– 
2(b)); and 
(ii) in the case of any taxpayer filing 
their tax return electronically, in a manner 
that maximizes the opportunity for such 
taxpayer, as part of the process of filing 
such return, to immediately— 
(I) obtain a determination with 
respect to the eligibility of any house-
hold member for any insurance af-
fordability program; and 
(II) enroll in minimum essential 
coverage. 
(e) ERRORS THAT AFFECT ELIGIBILITY FOR INSUR-
ANCE AFFORDABILITY PROGRAMS.—The Secretary of 
Health and Human Services, in consultation with the Sec-
retary, shall establish procedures for addressing instances 
in which an error in relevant return information that was 
transferred to an Exchange under subsection (d) may have 
resulted in a determination that an individual is eligible 
for more or less assistance under an insurance afford-
ability program than the assistance for which the indi-
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vidual would otherwise have been eligible without the 
error. Such procedures shall include procedures for— 
(1) the reporting of such error to the individual, 
the Secretary of Health and Human Services, and 
the applicable Exchange and insurance affordability 
program, regardless of whether such error was in-
cluded in an amendment to the tax return; and 
(2) correcting, as soon as practicable, the indi-
vidual’s eligibility status for insurance affordability 
programs, subject to, in the case of reduced eligi-
bility for assistance, any right of notice and appeal 
under laws governing the applicable insurance af-
fordability program, including section 1411(f) of the 
Patient Protection and Affordable Care Act (42 
U.S.C. 18081(f)). 
(f) DISCLOSURE OF RETURN INFORMATION FOR DE-
TERMINING
ELIGIBILITY
FOR
INSURANCE
AFFORD-
ABILITY PROGRAMS AND ENROLLMENT INTO MINIMUM 
ESSENTIAL HEALTH COVERAGE.— 
(1) IN GENERAL.—Section 6103(l) of the Inter-
nal Revenue Code of 1986 is amended by adding at 
the end the following: 
‘‘(23) DISCLOSURE OF RETURN INFORMATION 
FOR DETERMINING ELIGIBILITY FOR INSURANCE AF-
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FORDABILITY
PROGRAMS
AND
ENROLLMENT
INTO 
MINIMUM ESSENTIAL HEALTH COVERAGE.— 
‘‘(A) IN
GENERAL.—In the case of any 
taxpayer who has consented to the disclosure 
and transfer of any relevant return information 
with respect to any household member pursuant 
to section 3(b) of the Easy Enrollment in 
Health Care Act, the Secretary shall disclose 
such information to the applicable Exchange. 
‘‘(B) RESTRICTION ON DISCLOSURE.—Re-
turn information disclosed under subparagraph 
(A) may be— 
‘‘(i) used by an Exchange only for the 
purposes of, and to the extent necessary 
in— 
‘‘(I) determining eligibility for an 
insurance affordability program, or 
‘‘(II) facilitating enrollment into 
minimum essential coverage, and 
‘‘(ii) further disclosed by an Exchange 
to any other person only for the purposes 
of, and to the extent necessary, to carry 
out subclauses (I) and (II) of clause (i). 
‘‘(C) DEFINITIONS.—For purposes of this 
paragraph, the terms ‘relevant return informa-
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tion’, ‘Exchange’, ‘insurance affordability pro-
gram’, and ‘minimum essential coverage’ have 
the same meanings given such terms under sec-
tion 2 of the Easy Enrollment in Health Care 
Act.’’. 
(2) SAFEGUARDS.—Section 6103(p)(4) of the 
Internal Revenue Code of 1986 is amended by in-
serting ‘‘or any Exchange described in subsection 
(l)(23),’’ after ‘‘or any entity described in subsection 
(l)(21),’’ each place it appears. 
(g) APPLICATIONS FOR INSURANCE AFFORDABILITY 
PROGRAMS WITHOUT RELIANCE ON FEDERAL INCOME 
TAX RETURNS.— 
(1) RULE OF CONSTRUCTION.—Nothing in this 
Act shall be construed as requiring any individual, 
as a condition of applying for an insurance afford-
ability program, to— 
(A) file a return of tax for any taxable 
year for which filing a return of tax would not 
otherwise be required for such taxable year; or 
(B) consent to disclosure of relevant return 
information under subsection (b)(1)(B)(i). 
(2) METHODS AND PROCEDURES.—Any agency 
administering an insurance affordability program 
shall implement methods and procedures, as pre-
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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(b); 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(c)). 
(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 (42 U.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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of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18083); and 
(ii) the circumstances for administra-
tive renewal of eligibility for the Medicaid 
program and the CHIP program, based on 
data showing probable continued eligibility. 
(C) DEFAULT.—In the case of a State de-
scribed in subparagraph (A) that does not se-
lect an option from the set presented under 
such subparagraph within a timeframe specified 
by the Secretary of Health and Human Serv-
ices, the Secretary of Health and Human Serv-
ices shall determine the option that the Ex-
change shall use for such State for the purposes 
described in such subparagraph. 
(D) RULE OF CONSTRUCTION.—Nothing in 
this paragraph shall be construed as requiring 
a State to provide benefits under title XIX or 
XXI of the Social Security Act (42 U.S.C. 1396 
et seq., 1397aa et seq.) to a category of individ-
uals, or to set an income eligibility threshold for 
benefits under such titles at a certain level, if 
the State is not otherwise required to do so 
under such titles. 
(2) ENROLLMENT.— 
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(A) IN GENERAL.—If the Exchange in a 
State determines that an individual described in 
paragraph (1)(A) is eligible for benefits under 
the State Medicaid program or CHIP program, 
the Exchange shall send the relevant informa-
tion about the individual to the State and, if 
consent 
has 
been 
given 
under 
section 
3(b)(1)(B) to enrollment in a health plan or 
other form of minimum essential coverage with 
a zero net premium, the State shall enroll such 
individual in the State Medicaid program or 
CHIP program (as applicable) as soon as prac-
ticable, except as provided in subparagraphs 
(B) and (D). 
(B) EXCEPTION.—A State shall not enroll 
an individual in coverage under the State Med-
icaid program or CHIP program without the af-
firmative consent of the individual if the indi-
vidual would be required to pay a premium for 
such coverage. 
(C) MANAGED CARE.—If the State Med-
icaid program or CHIP program requires an in-
dividual enrolled under subparagraph (A) to re-
ceive coverage through a managed care organi-
zation or entity, the State shall use a procedure 
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for assigning the individual to such an organi-
zation or entity (including auto-assignment pro-
cedures) that is commonly used in the State 
when an individual who is found eligible for 
such program does not affirmatively select a 
particular organization or entity. 
(D) 
OPT-OUT
PROCEDURES.—Notwith-
standing subparagraph (A), an individual de-
scribed in such subparagraph shall be given one 
or more opportunities to opt out of coverage 
under a State Medicaid program or CHIP pro-
gram, using procedures prescribed by the Sec-
retary of Health and Human Services. 
(c) ADVANCE PREMIUM TAX CREDITS FOR QUALI-
FIED HEALTH PLANS.— 
(1) IN GENERAL.—In the case where a taxpayer 
has filed their return of tax for a taxable year on or 
before the date specified under section 6072(a) of 
the Internal Revenue Code of 1986 with respect to 
such year and has provided consent described in sec-
tion 3(b)(1)(B)(i), if the Exchange has determined 
that an applicable household member has not quali-
fied for the Medicaid program or the CHIP pro-
gram, such Exchange shall— 
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(A) in addition to any such period that 
may otherwise be available, provide a special 
enrollment period that begins on the date the 
taxpayer has provided such consent; and 
(B) determine— 
(i) whether the taxpayer would, pursu-
ant to section 1412 of the Patient Protec-
tion and Affordable Care Act (42 U.S.C. 
18082), be eligible for advance payment of 
the premium assistance tax credit under 
section 36B of the Internal Revenue Code 
of 1986 if such household member of the 
taxpayer were enrolled in a qualified health 
plan; and 
(ii) if the taxpayer has made the elec-
tion described in section 3(b)(1)(B)(ii), 
whether such household member has one 
or more options to enroll in a qualified 
health plan with a zero net premium. 
(2) ENROLLMENT
IN
A
QUALIFIED
HEALTH 
PLAN WITH A ZERO NET PREMIUM.— 
(A) IN
GENERAL.—In the case that a 
household member described in paragraph (1) 
has one or more options to enroll in a qualified 
health plan with a zero net premium, and con-
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sent has been given under section 3(b)(1)(B) 
for enrollment of such household member in a 
qualified health plan with a zero net premium— 
(i) the Exchange shall identify a set of 
options (as described in subparagraph (B)) 
for qualified health plans offering a zero 
net premium; and 
(ii) from such set, select a qualified 
health plan as the default enrollment 
choice for the household member in accord-
ance with subparagraph (C). 
(B) OPTION SETS.— 
(i) IN
GENERAL.—In the case that 
multiple qualified health plans with a zero 
net premium are available with more than 
1 actuarial value, the Exchange shall limit 
the set of options under subparagraph 
(A)(i) to such qualified health plans with 
the highest available actuarial value. 
(ii) FURTHER RESTRICTIONS.—In the 
case described in clause (i), the Exchange 
may further limit the set of options under 
subparagraph (A)(i), among the qualified 
health plans that have the highest available 
actuarial value as described in clause (i), 
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based on the generosity of such plans’ cov-
erage of services not subject to a deduct-
ible. 
(iii) DEFINITION OF HIGHEST ACTU-
ARIAL VALUE.—For purposes of this sub-
paragraph, the term ‘‘highest actuarial 
value’’ means the highest actuarial value 
among— 
(I) the levels of coverage de-
scribed in paragraph (1) of section 
1302(d) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 
18022(d)), without regard to allow-
able variance under paragraph (3) of 
such section; and 
(II) as applicable, the levels of 
coverage that result from the applica-
tion of cost-sharing reductions under 
section 1402 of such Act (42 U.S.C. 
18071). 
(C) SELECTING A DEFAULT OPTION.—The 
Secretary of Health and Human Services shall 
establish procedures that Exchanges may use in 
selecting, from the set of options described in 
subparagraph (B), the default enrollment choice 
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under subparagraph (A)(ii). Such procedures 
shall include— 
(i) State options for randomization 
among health insurance issuers; and 
(ii) factors that may be used to weight 
such randomization. 
(D) NOTIFICATION OF DEFAULT ENROLL-
MENT.—As soon as possible after an Exchange 
has identified a default enrollment choice for an 
individual under subparagraph (A)(ii), the Ex-
change shall provide the individual with notice 
of such selection. The notice shall include— 
(i) a description of coverage provided 
by the selected qualified health plan; 
(ii) encouragement to learn about all 
available qualified health plan options be-
fore the end of the special enrollment pe-
riod under paragraph (1)(A) and to select 
a plan that best meets the needs of the in-
dividual and the individual’s family; 
(iii) an explanation that, if the indi-
vidual does not select a qualified health 
plan by the end of such special enrollment 
period or opt out of default enrollment in 
accordance with the process described in 
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clause (iv), the Exchange will enroll the in-
dividual in such selected qualified health 
plan in accordance with subparagraph (E); 
(iv) an explanation of the opt-out 
process preceding implementation of de-
fault enrollment, which shall meet stand-
ards prescribed by the Secretary of Health 
and Human Services; and 
(v) information on options for assist-
ance with enrollment and plan choice, in-
cluding publicly funded navigators and pri-
vate brokers and agents approved by the 
Exchange. 
(E) DEFAULT ENROLLMENT.— 
(i) IN GENERAL.—Subject to subpara-
graph (F), an Exchange shall enroll in a 
default enrollment choice any individual 
who— 
(I) is sent a notice under sub-
paragraph (D); and 
(II) fails to select a different 
qualified health plan, or opt out of de-
fault enrollment under this paragraph, 
by the end of the special enrollment 
period described in paragraph (1)(A). 
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(ii) UPDATED NOTICE.—At the time 
of the default enrollment described in 
clause (i), the Exchange shall send a notice 
to the individual explaining that default 
enrollment has occurred, describing the 
plan into which the individual has been en-
rolled, and explaining the reconsideration 
procedures described in subparagraph (F). 
(F) RECONSIDERATION.— 
(i) IN GENERAL.—Not later than 30 
days after receiving a notice under sub-
paragraph (E)(ii), the individual receiving 
such notice may use a method provided by 
the Exchange to indicate— 
(I) the individual’s decision to 
disenroll from the qualified health 
plan selected under subparagraph 
(A)(ii); or 
(II) in the case of a household 
member for whom the selected quali-
fied health plan under such subpara-
graph is a high cost-sharing qualified 
health plan, the individual’s decision 
to enroll in a specified lower cost- 
sharing qualified health plan, identi-
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fied by the Exchange, that is offered 
by the same health insurance issuer 
that sponsors the qualified health plan 
that was selected under such subpara-
graph. 
(ii) DEFINITIONS.—For purposes of 
this subparagraph: 
(I) HIGH COST-SHARING QUALI-
FIED HEALTH PLAN.—The term ‘‘high 
cost-sharing qualified health plan’’ 
means— 
(aa) in the case of a house-
hold member with a household 
income at or below 200 percent 
of the poverty line, a qualified 
health plan that is not at the sil-
ver level; or 
(bb) in the case of a house-
hold member with a household 
income above 200 percent of the 
poverty line, a qualified health 
plan that is not at the gold or 
platinum level. 
(II) SPECIFIED
LOWER
COST- 
SHARING QUALIFIED HEALTH PLAN.— 
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The term ‘‘specified lower cost-shar-
ing qualified health plan’’ means— 
(aa) in the case of a house-
hold member with a household 
income at or below 200 percent 
of the poverty line, the lowest- 
premium qualified health plan of-
fered by the health insurance 
issuer that is at the silver level; 
or 
(bb) in the case of a house-
hold member with a household 
income above 200 percent of the 
poverty line, the lowest-premium 
qualified health plan offered by 
the health insurance issuer that 
is at the gold level. 
SEC. 5. MODERNIZING ELIGIBILITY CRITERIA FOR INSUR-
ANCE AFFORDABILITY PROGRAMS. 
(a) IMPROVING
THE
STABILITY
AND
PREDICT-
ABILITY OF MEDICAID AND CHIP COVERAGE.— 
(1) IN GENERAL.—Section 1902(e) of the So-
cial Security Act (42 U.S.C. 1396a(e)) is amended 
by striking paragraph (12) and inserting the fol-
lowing: 
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‘‘(12) CONTINUOUS ELIGIBILITY.— 
‘‘(A) CONTINUOUS
ELIGIBILITY
OPTION 
FOR CHILDREN.—At the option of the State, 
the plan may provide that an individual who is 
under an age specified by the State (not to ex-
ceed 19 years of age) and who is determined to 
be eligible for benefits under a State plan ap-
proved under this title under subsection 
(a)(10)(A) shall remain eligible for those bene-
fits until the earlier of— 
‘‘(i) the end of a period (not to exceed 
12 months) following the determination; or 
‘‘(ii) the time that the individual ex-
ceeds that age. 
‘‘(B) CONTINUOUS
COVERAGE
FOR
CER-
TAIN
ELIGIBLE
INDIVIDUALS
SUBJECT
TO 
MODIFIED
ADJUSTED
GROSS
INCOME
CRI-
TERIA.— 
‘‘(i) IN GENERAL.—At the option of 
the State, the State may provide that an 
individual who is determined to be eligible 
for benefits under the State plan (or a 
waiver of such plan), who is under such 
age as the State may specify, and whose 
eligibility is based on satisfaction of modi-
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fied adjusted gross income requirements 
shall remain eligible for those benefits until 
the end of a period specified by the State 
(not to exceed 12 months) following such 
determination. 
‘‘(ii) REQUIREMENT TO PROVIDE CON-
TINUOUS COVERAGE FROM 2023 TO 2030.— 
During the period beginning on January 1, 
2023, and ending on December 31, 2030, 
clause (i) shall be applied— 
‘‘(I) by substituting ‘The State 
shall provide’ for ‘At the option of the 
State, the State may provide’; 
‘‘(II) by striking ‘, who is under 
such age as the State may specify,’; 
and 
‘‘(III) by substituting ‘the 12 
month period’ for ‘a period specified 
by the State (not to exceed 12 
months)’. 
‘‘(C) 
ELIGIBILITY
CATEGORY
FLEXI-
BILITY.—A State shall ensure that, notwith-
standing the application of a continuous cov-
erage period under this paragraph, an indi-
vidual who is enrolled under the State plan (or 
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a waiver of such plan) shall be permitted to 
change the eligibility category under which the 
individual is enrolled during such a period if the 
new eligibility category would result in the indi-
vidual receiving greater benefits under the plan 
(or waiver) or in a reduction to the premiums 
or cost-sharing imposed on the individual under 
the plan (or waiver).’’. 
(2) APPLICATION TO CHIP.—Section 2107(e)(1) 
of the Social Security Act (42 U.S.C. 1397gg(e)(1)) 
is amended— 
(A) by redesignating subparagraphs (H) 
through (T) as subparagraphs (I) through (U), 
respectively; and 
(B) by inserting after subparagraph (G) 
the following new subparagraph: 
‘‘(H) Section 1902(e)(12) (relating to the 
provision of continuous coverage), except that, 
in addition to ensuring that an individual may 
change the eligibility category under which the 
individual is enrolled under this title during a 
continuous coverage period under such section, 
the State shall also ensure that an individual 
shall be permitted during such period to enroll 
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in the State plan under title XIX (or a waiver 
of such plan).’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect on October 1, 
2021. 
(b) INCOME
ELIGIBILITY
DETERMINATIONS
FOR 
MEDICAID AND CHIP.— 
(1) IN GENERAL.—Section 1902(e)(14)(D) of 
the Social Security Act (42 U.S.C. 1396a(e)(14)(D)) 
is amended by adding at the end the following new 
clauses: 
‘‘(vi) SNAP AND
TANF
ELIGIBILITY 
FINDINGS.— 
‘‘(I) IN
GENERAL.—Subject to 
subclause (III), a State shall provide 
that an individual for whom a finding 
has been made as described in clause 
(II) shall meet applicable eligibility for 
assistance under the State plan or a 
waiver of the plan involving financial 
eligibility, citizenship or satisfactory 
immigration status, and State resi-
dence. A State shall rely on such a 
finding both for the initial determina-
tion of eligibility for medical assist-
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ance under the plan or waiver and any 
subsequent redetermination of eligi-
bility. 
‘‘(II) FINDINGS
DESCRIBED.—A 
finding described in this subclause is 
a determination made within a rea-
sonable period (as determined by the 
Secretary) by a State agency respon-
sible for administering the Temporary 
Assistance for Needy Families pro-
gram under part A of title IV or the 
Supplemental 
Nutrition 
Assistance 
Program established under the Food 
and Nutrition Act of 2008 that an in-
dividual is eligible for benefits under 
such program. 
‘‘(III) 
LIMITATION.—A 
State 
shall be required to rely on the find-
ings of the State agency responsible 
for administering the supplemental 
nutrition assistance program estab-
lished under the Food and Nutrition 
Act of 2008 only in the case of— 
‘‘(aa) an individual who is 
under 19 years of age; or 
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‘‘(bb) an individual who is 
described 
in 
subsection 
(a)(10)(A)(i)(VIII). 
‘‘(IV) STATE OPTION.—A State 
may rely on the findings of the State 
agency responsible for administering 
the supplemental nutrition assistance 
program established under the Food 
and Nutrition Act of 2008 in the case 
of an individual not described in sub-
clause (III). 
‘‘(vii) RECENT ANNUAL INCOME ES-
TABLISHING ELIGIBILITY.— 
‘‘(I) IN GENERAL.—For purposes 
of determining the income eligibility 
for medical assistance of an individual 
whose eligibility is determined based 
on the application of modified ad-
justed gross income under subpara-
graph (A), a State shall provide that 
an individual whose eligibility date oc-
curs in January, February, March, or 
April of a calendar year shall be fi-
nancially eligible if the individual’s 
modified adjusted gross income for 
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the preceding calendar year satisfies 
the income eligibility requirement ap-
plicable to the individual. 
‘‘(II) 
DEFINITION.—For 
pur-
poses of this clause, an ‘eligibility 
date’ means— 
‘‘(aa) in the case of an indi-
vidual who is not receiving med-
ical assistance when the indi-
vidual applies for an insurance 
affordability program (as defined 
in section 2 of the Easy Enroll-
ment 
in 
Health 
Care 
Act), 
whether such application takes 
place through section 3(b) of 
such Act or otherwise, the date 
on which such individual applies 
for such program; and 
‘‘(bb) in the case of an indi-
vidual who is receiving medical 
assistance and whose continued 
eligibility for such assistance is 
being redetermined, the date on 
which the individual is deter-
mined to satisfy all eligibility re-
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quirements applicable to the indi-
vidual other than income eligi-
bility. 
‘‘(III) RULES
OF
CONSTRUC-
TION.— 
‘‘(aa) ELIGIBILITY
DETER-
MINATIONS
DURING
MAY 
THROUGH
DECEMBER.—Nothing 
in subclause (I) shall be con-
strued as diminishing, reducing, 
or otherwise limiting the State’s 
obligation to grant eligibility, 
under circumstances other than 
those described in such sub-
clause, based on data that in-
clude income shown on an indi-
vidual’s tax return, including the 
obligation 
under 
section 
1413(c)(3)(A) of the Patient 
Protection and Affordable Care 
Act (42 U.S.C. 18083(c)(3)(A)). 
‘‘(bb) 
ALTERNATIVE 
GROUNDS
FOR
ELIGIBILITY.— 
Nothing in subclause (I) shall be 
construed as diminishing, reduc-
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ing, 
or 
otherwise 
limiting 
grounds for eligibility other than 
those described in such sub-
clause, including eligibility based 
on income as of the point in time 
at which an application for med-
ical assistance under the State 
plan or a waiver of the plan is 
processed. 
‘‘(cc) QUALIFYING FOR AD-
DITIONAL
ASSISTANCE.—Not-
withstanding subclause (I), a 
State shall use an individual’s 
modified adjusted gross income 
as determined as of the point in 
time at which the individual’s ap-
plication for medical assistance is 
processed or, in the case of rede-
termination of eligibility, pro-
jected annual income, to deter-
mine the individual’s eligibility 
for medical assistance if using 
the individual’s modified adjusted 
gross income, as so determined, 
would result in the individual 
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being eligible for greater benefits 
under the State plan (or a waiver 
of such plan) or in the imposition 
of lower premiums or cost-shar-
ing on the individual under the 
plan (or waiver) than if the indi-
vidual’s eligibility was determined 
using the modified adjusted gross 
income of the individual as shown 
on the individual’s tax return for 
the preceding calendar year.’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
1902(e)(14)(H)(i) of the Social Security Act (42 
U.S.C. 1396a(e)(14)(H)(i)) is amended by inserting 
‘‘except as provided in subparagraph (D)(vii)(I),’’ 
before ‘‘the requirement’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect on January 1, 
2023. 
(c) IMPROVING THE STABILITY AND PREDICTABILITY 
OF EXCHANGE COVERAGE.— 
(1) INTERNAL REVENUE CODE OF 1986.—Sec-
tion 36B of the Internal Revenue Code of 1986 is 
amended— 
(A) in subsection (b)— 
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(i) in paragraph (2)(B)(ii), by striking 
‘‘taxable year’’ and inserting ‘‘applicable 
tax year’’, and 
(ii) in paragraph (3)— 
(I) in subparagraph (A)— 
(aa) in clause (i), by striking 
‘‘taxable year’’ and inserting ‘‘ap-
plicable taxable year’’, and 
(bb) in clause (ii)(I), by in-
serting ‘‘(or, in the case of appli-
cable taxable years beginning in 
any calendar year after 2023)’’ 
after ‘‘2014’’, and 
(II) in subparagraph (B)— 
(aa) in clause (ii)(I)(aa), by 
striking ‘‘the taxable year’’ each 
place it appears and inserting 
‘‘the applicable taxable year’’, 
and 
(bb) in the flush matter at 
the end— 
(AA) striking ‘‘files a 
joint return and no credit is 
allowed’’ and inserting ‘‘filed 
a joint return during the ap-
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plicable taxable year and no 
credit was allowed’’, and 
(BB) striking ‘‘unless a 
deduction is allowed under 
section 151 for the taxable 
year’’ and inserting ‘‘unless 
a deduction was allowed 
under section 151 for the 
applicable taxable year’’, 
(B) in subsection (c)— 
(i) in paragraph (1)— 
(I) in subparagraphs (A) and 
(C), by striking ‘‘taxable year’’ each 
place it appears and inserting ‘‘appli-
cable taxable year’’, and 
(II) in subparagraph (D), by 
striking ‘‘is allowable’’ and all that 
follows through the period and insert-
ing ‘‘was allowable to another tax-
payer 
for 
the 
applicable 
taxable 
year.’’, 
(ii) in paragraph (2)(C), by adding at 
the end the following: 
‘‘(v) TIME PERIOD.— 
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‘‘(I) IN
GENERAL.—Except as 
provided under subclause (II), eligi-
bility for minimum essential coverage 
under this subparagraph shall be 
based on the individual’s eligibility for 
employer-sponsored minimum essen-
tial coverage during the open enroll-
ment period (or during a special en-
rollment period for an individual who 
enrolls or who changes their qualified 
health plan during a special enroll-
ment period), as determined by the 
applicable Exchange. 
‘‘(II) EXCEPTION.—An individual 
shall be considered eligible for min-
imum essential coverage under clause 
(iii) for a month for which such Ex-
change has determined, subject to 
rights of notice and appeal under laws 
governing the applicable insurance af-
fordability program (including section 
1411(f) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 
18081(f))), that the individual is cov-
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ered by an eligible employer-sponsored 
plan.’’, and 
(iii) by adding at the end the fol-
lowing: 
‘‘(5) APPLICABLE TAXABLE YEAR.—The term 
‘applicable taxable year’ means— 
‘‘(A) with respect to a coverage month that 
is January, February, March, April, or May, 
the most recent taxable year that ended at least 
12 months before January 1 of the plan year, 
and 
‘‘(B) with respect to any coverage month 
not described in subparagraph (A), the most re-
cent taxable year that ended before January 1 
of the plan year. 
‘‘(6) EXCHANGE.—The term ‘Exchange’ means 
an American Health Benefit Exchange established 
under subtitle D of title I of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18021 et seq.). 
‘‘(7) OPEN ENROLLMENT PERIOD.—The term 
‘open enrollment period’ means an open enrollment 
period described in subsection (c)(6)(B) of section 
1311 of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18031).’’, 
(C) in subsection (d)— 
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(i) in paragraph (1)— 
(I) by striking ‘‘is allowed’’ and 
inserting ‘‘was allowed’’, and 
(II) by inserting ‘‘applicable’’ be-
fore ‘‘taxable year’’, 
(ii) in paragraph (3)(B), by inserting 
‘‘applicable’’ before ‘‘taxable year’’, 
(D) in subsection (e)(1)— 
(i) by striking ‘‘is allowed’’ and insert-
ing ‘‘was allowed’’, and 
(ii) by inserting ‘‘applicable’’ before 
‘‘taxable year’’, and 
(E) in subsection (f)(2)— 
(i) in subparagraph (A), by striking 
‘‘If’’ and inserting ‘‘Except as provided in 
subparagraphs (B) and (C), if’’, and 
(ii) by inserting at the end the fol-
lowing: 
‘‘(C) SAFE HARBOR.— 
‘‘(i) INCOME AND FAMILY SIZE.—No 
increase under subparagraph (A) shall be 
imposed if the advance payments do not 
exceed amounts that are consistent with 
income and family size, either— 
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‘‘(I) as shown on the return of 
tax for the applicable plan year, pro-
vided such return was accepted by the 
Secretary as meeting applicable proc-
essing criteria, or 
‘‘(II) as determined by the appli-
cable 
Exchange 
under 
subsection 
(b)(4) of section 1412 of the Patient 
Protection and Affordable Care Act 
(42 U.S.C. 18082). 
‘‘(ii) EMPLOYER-SPONSORED MINIMUM 
ESSENTIAL COVERAGE.—No increase under 
subparagraph (A) shall be imposed based 
on eligibility for minimum essential cov-
erage under subsection (c)(2)(C) if the ap-
plicable Exchange— 
‘‘(I) determined, under clause 
(v)(I) of such subsection, that the in-
dividual was ineligible for employer- 
sponsored minimum essential cov-
erage, and 
‘‘(II) did not determine, under 
clause (v)(II) of such subsection, that 
the individual was covered through 
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employer-sponsored minimum essen-
tial coverage. 
‘‘(iii) EXCEPTION.—Clauses (i) and 
(ii) shall not apply to the extent that any 
determination described in such clauses 
was based on a false statement by the tax-
payer which— 
‘‘(I) was intentional or grossly 
negligent, and 
‘‘(II) was— 
‘‘(aa) made on a return of 
tax, or 
‘‘(bb) provided or caused to 
be provided to an Exchange by 
the taxpayer.’’. 
(2) PATIENT
PROTECTION
AND
AFFORDABLE 
CARE ACT.—Section 1412(b) of the Patient Protec-
tion and Affordable Care Act (42 U.S.C. 18082(b)) 
is amended— 
(A) in paragraph (1)(B), by striking ‘‘the 
most recent’’ and all that follows through the 
period at the end and inserting ‘‘the applicable 
taxable year, as defined in section 36B(c)(5) of 
the Internal Revenue Code of 1986.’’; 
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(B) in paragraph (2)(B), by striking ‘‘sec-
ond preceding taxable year’’ and inserting ‘‘ap-
plicable taxable year, as defined in such section 
36B(c)(5)’’; and 
(C) by adding at the end the following: 
‘‘(3) CHANGE FORM.—If, after the submission 
of an individual’s application form, the individual ex-
periences changes in circumstances as described in 
paragraph (2), the individual may, by submitting a 
change form as prescribed by the Secretary, apply 
for an increased amount of advance payments of the 
premium tax credit under section 36B of the Inter-
nal Revenue Code of 1986, increased cost-sharing 
reductions under section 1402, increased assistance 
under the basic health program under section 1331, 
and coverage through a State Medicaid program or 
CHIP program. 
‘‘(4) ELIGIBILITY
FOR
ADDITIONAL
ASSIST-
ANCE.— 
‘‘(A) IN GENERAL.—The Secretary, in con-
sultation with the Secretary of the Treasury, 
shall establish a process through which— 
‘‘(i) an Exchange determines, through 
data sources and procedures described in 
sections 1411 and 1413 (42 U.S.C. 18081; 
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42 U.S.C. 18083), whether each individual 
who has submitted a change form under 
paragraph (3) has experienced substantial 
changes in circumstances that warrant ad-
ditional assistance through an insurance 
affordability program, as defined in section 
2 of the Easy Enrollment in Health Care 
Act; 
‘‘(ii) in the case the Exchange deter-
mines an individual has experienced sub-
stantial changes in circumstances as de-
scribed in clause (i), the Exchange conveys 
such determination to the Secretary of the 
Treasury under section 36B(f) of the In-
ternal Revenue Code of 1986 and to the 
administrator of an insurance affordability 
program for which the individual may 
qualify under that determination; and 
‘‘(iii) in the case the Exchange deter-
mines an individual has experienced sub-
stantial changes in circumstances described 
in clause (i), the individual may qualify 
without delay for additional advance pre-
mium tax credits under section 36B of the 
Internal Revenue Code of 1986, increased 
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cost-sharing 
reductions 
under 
section 
1402, additional basic health program as-
sistance under section 1331, or coverage 
through a State Medicaid program or 
CHIP program. 
‘‘(B) RIGHTS TO NOTICE AND APPEAL.—A 
determination made by an Exchange under this 
paragraph shall be subject to any applicable 
rights of notice and appeal, including such 
rights under section 1411(f).’’. 
(3) 
EFFECTIVE
DATES.—The 
amendments 
made by this subsection shall take effect on January 
1, 2024, and continue in effect through December 
31, 2030. 
SEC. 6. STRENGTHENING DATA INFRASTRUCTURE FOR ELI-
GIBILITY FOR INSURANCE AFFORDABILITY 
PROGRAMS. 
(a) INSURANCE AFFORDABILITY PROGRAM ACCESS 
TO NATIONAL DIRECTORY
OF NEW HIRES.—Section 
453(i) of the Social Security Act (42 U.S.C. 653(i)) is 
amended by adding at the end the following new para-
graphs: 
‘‘(5) ADMINISTRATION OF INSURANCE AFFORD-
ABILITY PROGRAMS.— 
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‘‘(A) IN
GENERAL.—The Secretary shall 
provide access to insurance affordability pro-
grams (as such term is defined in section 2 of 
the Easy Enrollment in Health Care Act) to in-
formation in the National Directory of New 
Hires that involves— 
‘‘(i) 
identity, 
employer, 
quarterly 
wages, and unemployment compensation, 
to the extent such information is poten-
tially relevant to determining the eligibility 
or scope of coverage of an individual for 
benefits provided by such a program; and 
‘‘(ii) new hires, to the extent such in-
formation is potentially relevant to deter-
mining whether an individual is offered 
minimum essential coverage through a 
group health plan, as defined in section 
5000(b)(1) of the Internal Revenue Code 
of 1986. 
‘‘(B) REIMBURSEMENT OF HHS COSTS.— 
Insurance affordability programs shall reim-
burse the Secretary, in accordance with sub-
section (k)(3), for the additional costs incurred 
by the Secretary in furnishing information 
under this paragraph.’’. 
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(b) USE OF INFORMATION FROM THE NATIONAL DI-
RECTORY OF NEW HIRES.—Notwithstanding any other 
provision of law— 
(1) in determining an individual’s eligibility for 
advance payment of premium tax credits under sec-
tion 1412(a)(3) of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18082(a)(3)), and 
cost-sharing reductions under section 1402 of the 
Patient Protection and Affordable Care Act (42 
U.S.C. 18071), and a basic health program under 
section 1331 of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18051), an Exchange may 
use information about identity, employer, quarterly 
wages, and unemployment compensation in the Na-
tional Directory of New Hires, and information 
about new hires to determine whether an individual 
is offered minimum essential coverage through a 
group health plan, as defined in section 5000(b)(1) 
of the Internal Revenue Code of 1986, subject to no-
tice and appeal rights for any resulting eligibility de-
termination, including the rights described in section 
1411(f) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18081(f)); and 
(2) Medicaid programs and CHIP programs 
may use information in the National Directory of 
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New Hires about identity, employer, quarterly 
wages, and unemployment compensation to deter-
mine eligibility and to implement third-party liability 
procedures or premium assistance programs other-
wise permitted or mandated under Federal law, and 
use information about new hires to implement such 
procedures and policies, subject to notice and appeal 
rights for any resulting determination, including 
those available under title XIX or title XXI of the 
Social Security Act or under section 1411(f) of the 
Patient Protection and Affordable Care Act (42 
U.S.C. 18081(f)). 
(c) USE OF INFORMATION ABOUT ELIGIBILITY FOR 
OR RECEIPT OF GROUP HEALTH COVERAGE.—Notwith-
standing any other provision of Federal or State law: 
(1) IN GENERAL.—Subject to the requirements 
described in paragraph (2), for purposes of deter-
mining eligibility and, in the case of a Medicaid pro-
gram, for purposes of determining the applicability 
of third-party liability procedures or premium assist-
ance policies otherwise permitted or mandated under 
Federal law, an insurance affordability program 
shall have access to any source of information, main-
tained by or accessible to a public entity, about re-
ceipt or offers of coverage through a group health 
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plan, as defined in section 2 of the Easy Enrollment 
in Health Care Act. Such sources shall include— 
(A) information maintained by or acces-
sible to the Secretary of Health and Human 
Services for purposes of implementing section 
1862(b) of the Social Security Act (42 U.S.C. 
1395y(b)); 
(B) information maintained by or acces-
sible to a State Medicaid program for purposes 
of implementing subsections (a)(25) or (a)(60) 
of section 1902 of the Social Security Act (42 
U.S.C. 1396a); and 
(C) information reported under sections 
6055 and 6056 of the Internal Revenue Code of 
1986. 
(2) REQUIREMENTS.—An insurance afford-
ability program shall obtain the information de-
scribed in paragraph (1) pursuant to an interagency 
or other agreement, consistent with standards pre-
scribed by the Secretary of Health and Human Serv-
ices, in consultation with the Secretary, that pre-
vents the unauthorized use, disclosure, or modifica-
tion of such information and otherwise protects pri-
vacy and data security. 
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(d) AUTHORIZATION TO RECEIVE RELEVANT INFOR-
MATION.— 
(1) IN GENERAL.—Notwithstanding any other 
provision of law, a Federal or State agency or pri-
vate entity in possession of the sources of data po-
tentially relevant to eligibility for an insurance af-
fordability program is authorized to convey such 
data or information to the insurance affordability 
program, and such program is authorized to receive 
the data or information and to use it in determining 
eligibility. 
(2) APPLICATION OF REQUIREMENTS AND PEN-
ALTIES.—A conveyance of data to an insurance af-
fordability program under this subsection shall be 
subject to the same requirements that apply to a 
conveyance of data to a State Medicaid plan under 
title XIX of the Social Security Act (42 U.S.C. 1396 
et seq.) under section 1942 of such Act (42 U.S.C. 
1396w–2), and the penalties that apply to a viola-
tion of such requirements, including penalties that 
apply to a private entity making a conveyance. 
(e) ELECTRONIC TRANSMISSION OF INFORMATION.— 
In determining an individual’s eligibility for an insurance 
affordability program, the program shall— 
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(1) with respect to verifying an element of eligi-
bility that is based on information from an Express 
Lane Agency (as defined in section 1902(e)(13)(F) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396a(e)(13)(F))), from another public agency, or 
from another reliable source of relevant data, waive 
any otherwise applicable requirement that the indi-
vidual must verify such information, provide an at-
testation as to the subject of such information, or 
provide a signature for attestations that include that 
subject, before the individual is enrolled into min-
imum essential coverage; and 
(2) satisfy any otherwise applicable signature 
requirement with respect to an individual’s enroll-
ment in an insurance affordability program through 
an electronic signature (as defined in section 
1710(1) of the Government Paperwork Elimination 
Act (44 U.S.C. 3504 note)). 
(f) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed as diminishing, reducing, or other-
wise limiting the legal authority for an insurance afford-
ability program to grant eligibility, in whole or in part, 
based on an attestation alone, without requiring 
verification through data matches or other sources. 
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SEC. 7. FUNDING FOR INFORMATION TECHNOLOGY DEVEL-
OPMENT AND OPERATIONS. 
(a) IN GENERAL.—Out of amounts in the Treasury 
not otherwise appropriated, there are appropriated to the 
Secretary of Health and Human Services such sums as 
may be necessary to establish information exchange and 
processing infrastructure and operate all information ex-
change and processing procedures described in this Act, 
including for the costs of staff and contractors. 
(b) AGENCIES RECEIVING FUNDING.—The Secretary 
of Health and Human Services may, as necessary and in 
accordance with the procedures described in subsection 
(c), transfer amounts appropriated under subsection (a) 
to entities that include the following for the purposes de-
scribed in such subsection: 
(1) The Secretary of the Treasury, including 
the Internal Revenue Service. 
(2) The Office of Child Support Enforcement of 
the Department of Health and Human Services. 
(3) A State-administered insurance affordability 
program, including a Medicaid or CHIP program 
and a State basic health program under section 
1331 of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18051). 
(4) An entity operating an Exchange. 
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(5) A third-party data source, which may be a 
public or private entity. 
(c) PROCEDURES.—The Secretary of Health and 
Human Services, in consultation with the Secretary of the 
Treasury, shall establish procedures for the entities de-
scribed in subsection (b) to request a transfer of funding 
from the amounts appropriated under subsection (a), in-
cluding procedures for reviewing such requests, modifying 
and approving such requests, appealing decisions about 
transfers, and auditing such transfers. 
SEC. 8. CONFORMING STATUTORY CHANGES. 
(a) STATE INCOME AND ELIGIBILITY VERIFICATION 
SYSTEMS.—Section 1137 of the Social Security Act (42 
U.S.C. 1320b–7) is amended— 
(1) in subsection (a)(1), by inserting ‘‘(in the 
case of an individual who has consented to the dis-
closure and transfer of relevant return information 
that includes the individual’s social security account 
number pursuant to section 3(b)(1)(B) of the Easy 
Enrollment in Health Care Act, the State shall deem 
such individual to have satisfied the requirement to 
furnish such account number to the State under this 
paragraph)’’ before the semicolon; and 
(2) in subsection (d)— 
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