I 
119TH CONGRESS 
1ST SESSION H. R. 3947 
To streamline enrollment in health insurance affordability programs and 
minimum essential coverage, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 12, 2025 
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) FAMILY SIZE.—The term ‘‘family size’’ has 
the meaning given such term in section 36B(d) of 
the Internal Revenue Code of 1986. 
(4) 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. 
(5) HOUSEHOLD INCOME.—The term ‘‘house-
hold income’’ has the meaning given such term in 
section 36B(d) of the Internal Revenue Code of 
1986. 
(6) HOUSEHOLD MEMBER.—The term ‘‘house-
hold member’’ means the taxpayer, the taxpayer’s 
spouse, and any dependent of the taxpayer. 
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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 (42 U.S.C. 
18082(a)(3)). 
(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— 
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(A) except as provided in subparagraph 
(B), means the payment from or on behalf of 
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-
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spect to a taxpayer, any return information, as de-
fined in section 6103(b)(2) of the Internal Revenue 
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. 
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(17) ZERO NET PREMIUM.—The term ‘‘zero net 
premium’’, with respect to a health plan or other 
form of minimum essential coverage, means a net 
premium of $0.00 for such plan or 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, 2028, 
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, 2026, 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— 
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(i) opt out of coverage through the 
zero-net-premium plan, or 
(ii) select a different plan. 
(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-
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fer by the Exchange to any other entity as 
is deemed necessary to accomplish such 
purposes; and 
(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, 
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may provide the elections under such paragraph as 
a single election or as 2 elections. 
(3) SUPPLEMENTAL FORM.— 
(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-
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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 
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 
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(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 
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 
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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 
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-
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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-
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.— 
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(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 
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 
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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-
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-
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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-
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.— 
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(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-
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 
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‘‘(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-
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— 
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(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-
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)). 
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(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— 
(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-
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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 
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 
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(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 
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) 
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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 
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-
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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 
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. 
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(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.— 
(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). 
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(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 
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. 
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(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— 
(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 
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(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-
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 
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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), 
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-
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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 
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— 
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(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 
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-
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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). 
(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-
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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-
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— 
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