241 
at such time, at such place, and in such manner as the 
Commissioner of Social Security determines appropriate. 
‘‘(D) Information provided by the Commissioner of 
Social Security to the Health Choices Commissioner pur-
suant to an agreement entered into pursuant to subpara-
graph (A) shall be considered as strictly confidential and 
shall be used only for the purposes described in this para-
graph and for carrying out such agreement. Any officer 
or employee or former officer or employee of the Health 
Choices Commissioner, or any officer or employee or 
former officer or employee of a contractor of the Health 
Choices Commissioner, who, without the written authority 
of the Commissioner of Social Security, publishes or com-
municates any information in such individual’s possession 
by reason of such employment or position as such an offi-
cer shall be guilty of a felony and, upon conviction thereof, 
shall be fined or imprisoned, or both, as described in sec-
tion 208. 
‘‘(3) The agreement entered into under paragraph (2) 
shall provide for funding to the Commissioner of Social 
Security consistent with section 341(b)(5) of Affordable 
Health Care for America Act. 
‘‘(4) This subsection shall apply in the case of a pub-
lic entity that conducts verifications under section 
341(b)(4) of the Affordable Health Care for America Act 
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242 
and the obligations of this subsection shall apply to such 
an entity in the same manner as such obligations apply 
to the Health Choices Commissioner when such Commis-
sioner is conducting such verifications.’’. 
(ii) CONFORMING AMENDMENT.—Sec-
tion 205(c)(2)(C) of such Act (42 U.S.C. 
405(c)(2)(C)) is amended by adding at the 
end the following new clause: 
‘‘(x) For purposes of the administration of the 
verification procedures described in section 341(b)(4) of 
the Affordable Health Care for America Act, the Health 
Choices Commissioner may collect and use social security 
account numbers as provided for in section 205(v)(1).’’. 
(B) IMPROVING THE INTEGRITY OF DATA 
AND
EFFECTIVENESS
OF
SAVE.—Section 
1137(d) of the Social Security Act (42 U.S.C. 
1320b–7(d)) is amended by adding at the end 
the following new paragraphs: 
‘‘(6)(A) With respect to the use by any agency of the 
system described in subsection (b) by programs specified 
in subsection (b) or any other use of such system, the U.S. 
Citizenship and Immigration Services and any other agen-
cy charged with the management of the system shall es-
tablish appropriate safeguards necessary to protect and 
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243 
improve the integrity and accuracy of data relating to indi-
viduals by— 
‘‘(i) establishing a process though which such 
individuals are provided access to, and the ability to 
amend, correct, and update, their own personally 
identifiable information contained within the system; 
‘‘(ii) providing a written response, without 
undue delay, to any individual who has made such 
a request to amend, correct, or update such individ-
ual’s own personally identifiable information con-
tained within the system; and 
‘‘(iii) developing a written notice for user agen-
cies to provide to individuals who are denied a ben-
efit due to a determination of ineligibility based on 
a final verification determination under the system. 
‘‘(B) The notice described in subparagraph (A)(ii) 
shall include— 
‘‘(i) information about the reason for such no-
tice; 
‘‘(ii) a description of the right of the recipient 
of the notice under subparagraph (A)(i) to contest 
such notice; 
‘‘(iii) a description of the right of the recipient 
under subparagraph (A)(i) to access and attempt to 
amend, correct, and update the recipient’s own per-
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244 
sonally identifiable information contained within 
records of the system described in paragraph (3); 
and 
‘‘(iv) instructions on how to contest such notice 
and attempt to correct records of such system relat-
ing to the recipient, including contact information 
for relevant agencies.’’. 
(C) STREAMLINING
ADMINISTRATION
OF 
VERIFICATION
PROCESS
FOR
UNITED
STATES 
CITIZENS.—Section 1902(ee)(2) of the Social 
Security Act (42 U.S.C. 1396a(ee)(2)) is 
amended by adding at the end the following: 
‘‘(D) In carrying out the verification procedures 
under this subsection with respect to a State, if the Com-
missioner of Social Security determines that the records 
maintained by such Commissioner are not consistent with 
an individual’s allegation of United States citizenship, 
pursuant to procedures which shall be established by the 
State in coordination with the Commissioner of Social Se-
curity, the Secretary of Homeland Security, and the Sec-
retary of Health and Human Services— 
‘‘(i) the Commissioner of Social Security shall 
inform the State of the inconsistency; 
‘‘(ii) upon being so informed of the inconsist-
ency, the State shall submit the information on the 
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245 
individual to the Secretary of Homeland Security for 
a determination of whether the records of the De-
partment of Homeland Security indicate that the in-
dividual is a citizen; 
‘‘(iii) upon making such determination, the De-
partment of Homeland Security shall inform the 
State of such determination; and 
‘‘(iv) information provided by the Commissioner 
of Social Security shall be considered as strictly con-
fidential and shall only be used by the State and the 
Secretary of Homeland Security for the purposes of 
such verification procedures. 
‘‘(E) Verification of status eligibility pursuant to the 
procedures established under this subsection shall be 
deemed a verification of status eligibility for purposes of 
this title, title XXI, and affordability credits under section 
341(b)(4) of the Affordable Health Care for America Act, 
regardless of the program in which the individual is apply-
ing for benefits.’’. 
(c) USE OF AFFORDABILITY CREDITS.— 
(1) IN GENERAL.—In Y1 and Y2 an affordable 
credit eligible individual may use an affordability 
credit only with respect to a basic plan. 
(2) FLEXIBILITY
IN
PLAN
ENROLLMENT
AU-
THORIZED.—Beginning with Y3, the Commissioner 
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shall establish a process to allow an affordability 
premium credit under section 343, but not the af-
fordability cost-sharing credit under section 344, to 
be used for enrollees in enhanced or premium plans. 
In the case of an affordable credit eligible individual 
who enrolls in an enhanced or premium plan, the in-
dividual shall be responsible for any difference be-
tween the premium for such plan and the afford-
ability credit amount otherwise applicable if the indi-
vidual had enrolled in a basic plan. 
(3) PROHIBITION OF USE OF PUBLIC FUNDS 
FOR ABORTION COVERAGE.—An affordability credit 
may not be used for payment for services described 
in section 222(d)(4)(A). 
(d) ACCESS TO DATA.—In carrying out this subtitle, 
the Commissioner shall request from the Secretary of the 
Treasury consistent with section 6103 of the Internal Rev-
enue Code of 1986 such information as may be required 
to carry out this subtitle. 
(e) NO CASH REBATES.—In no case shall an afford-
able credit eligible individual receive any cash payment as 
a result of the application of this subtitle. 
SEC. 342. AFFORDABLE CREDIT ELIGIBLE INDIVIDUAL. 
(a) DEFINITION.— 
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(1) IN GENERAL.—For purposes of this divi-
sion, the term ‘‘affordable credit eligible individual’’ 
means, subject to subsection (b) and section 346, an 
individual who is lawfully present in a State in the 
United States (other than as a nonimmigrant de-
scribed in a subparagraph (excluding subparagraphs 
(K), (T), (U), and (V)) of section 101(a)(15) of the 
Immigration and Nationality Act)— 
(A) who is enrolled under an Exchange- 
participating health benefits plan and is not en-
rolled under such plan as an employee (or de-
pendent of an employee) through an employer 
qualified health benefits plan that meets the re-
quirements of section 412; 
(B) with modified adjusted gross income 
below 400 percent of the Federal poverty level 
for a family of the size involved; 
(C) who is not a Medicaid eligible indi-
vidual, other than an individual during a transi-
tion period under section 302(d)(3)(B)(ii); and 
(D) subject to paragraph (3), who is not 
enrolled in acceptable coverage (other than an 
Exchange-participating health benefits plan). 
(2) TREATMENT
OF
FAMILY.—Except as the 
Commissioner may otherwise provide, members of 
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248 
the same family who are affordable credit eligible in-
dividuals shall be treated as a single affordable cred-
it individual eligible for the applicable credit for such 
a family under this subtitle. 
(3) SPECIAL
RULE
FOR
INDIANS.—Subpara-
graph (D) of paragraph (1) shall not apply to an in-
dividual who has coverage that is treated as accept-
able coverage for purposes of section 59B(d)(2) of 
the Internal Revenue Code of 1986 but is not treat-
ed as acceptable coverage for purposes of this divi-
sion. 
(b) LIMITATIONS ON EMPLOYEE AND DEPENDENT 
DISQUALIFICATION.— 
(1) IN GENERAL.—Subject to paragraph (2), 
the term ‘‘affordable credit eligible individual’’ does 
not include a full-time employee of an employer if 
the employer offers the employee coverage (for the 
employee and dependents) as a full-time employee 
under a group health plan if the coverage and em-
ployer contribution under the plan meet the require-
ments of section 412. 
(2) EXCEPTIONS.— 
(A) 
FOR
CERTAIN
FAMILY
CIR-
CUMSTANCES.—The Commissioner shall estab-
lish such exceptions and special rules in the 
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249 
case described in paragraph (1) as may be ap-
propriate in the case of a divorced or separated 
individual or such a dependent of an employee 
who would otherwise be an affordable credit eli-
gible individual. 
(B) FOR UNAFFORDABLE EMPLOYER COV-
ERAGE.—Beginning in Y2, in the case of full- 
time employees for which the cost of the em-
ployee premium for coverage under a group 
health plan would exceed 12 percent of current 
modified adjusted gross income (determined by 
the Commissioner on the basis of verifiable doc-
umentation), paragraph (1) shall not apply. 
(c) INCOME DEFINED.— 
(1) IN GENERAL.—In this title, the term ‘‘in-
come’’ means modified adjusted gross income (as de-
fined in section 59B of the Internal Revenue Code 
of 1986). 
(2) STUDY
OF
INCOME
DISREGARDS.—The 
Commissioner shall conduct a study that examines 
the application of income disregards for purposes of 
this subtitle. Not later than the first day of Y2, the 
Commissioner shall submit to Congress a report on 
such study and shall include such recommendations 
as the Commissioner determines appropriate. 
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(d) CLARIFICATION
OF TREATMENT
OF AFFORD-
ABILITY CREDITS.—Affordability credits under this sub-
title shall not be treated, for purposes of title IV of the 
Personal Responsibility and Work Opportunity Reconcili-
ation Act of 1996, to be a benefit provided under section 
403 of such title. 
SEC. 343. AFFORDABILITY PREMIUM CREDIT. 
(a) IN GENERAL.—The affordability premium credit 
under this section for an affordable credit eligible indi-
vidual enrolled in an Exchange-participating health bene-
fits plan is in an amount equal to the amount (if any) 
by which the reference premium amount specified in sub-
section (c), exceeds the affordable premium amount speci-
fied in subsection (b) for the individual, except that in no 
case shall the affordable premium credit exceed the pre-
mium for the plan. 
(b) AFFORDABLE PREMIUM AMOUNT.— 
(1) IN
GENERAL.—The affordable premium 
amount specified in this subsection for an individual 
for the annual premium in a plan year shall be equal 
to the product of— 
(A) the premium percentage limit specified 
in paragraph (2) for the individual based upon 
the individual’s modified adjusted gross income 
for the plan year; and 
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251 
(B) the individual’s modified adjusted 
gross income for such plan year. 
(2) PREMIUM PERCENTAGE LIMITS BASED ON 
TABLE.—The Commissioner shall establish premium 
percentage limits so that for individuals whose modi-
fied adjusted gross income is within an income tier 
specified in the table in subsection (d) such percent-
age limits shall increase, on a sliding scale in a lin-
ear manner, from the initial premium percentage to 
the final premium percentage specified in such table 
for such income tier. 
(c) REFERENCE PREMIUM AMOUNT.—The reference 
premium amount specified in this subsection for a plan 
year for an individual in a premium rating area is equal 
to the average premium for the 3 basic plans in the area 
for the plan year with the lowest premium levels. In com-
puting such amount the Commissioner may exclude plans 
with extremely limited enrollments. 
(d) TABLE OF PREMIUM PERCENTAGE LIMITS, AC-
TUARIAL VALUE PERCENTAGES, AND OUT-OF-POCKET 
LIMITS FOR Y1 BASED ON INCOME TIER.— 
(1) IN GENERAL.—For purposes of this sub-
title, subject to paragraph (3) and section 346, the 
table specified in this subsection is as follows: 
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In the case of 
modified adjusted 
gross income (ex-
pressed as a per-
cent of FPL) with-
in the following in-
come tier: 
The initial 
premium 
percentage 
is— 
The final 
premium 
percentage 
is— 
The actu-
arial value 
percentage 
is— 
The out-of- 
pocket limit 
for Y1 is— 
133% through 
150% 
1.5% 
3.0% 
97% 
$500 
150% through 
200% 
3.0% 
5.5% 
93% 
$1,000 
200% through 
250% 
5.5% 
8.0% 
85% 
$2,000 
250% through 
300% 
8.0% 
10.0% 
78% 
$4,000 
300% through 
350% 
10.0% 
11.0% 
72% 
$4,500 
350% through 
400% 
11.0% 
12.0% 
70% 
$5,000 
(2) SPECIAL RULES.—For purposes of applying 
the table under paragraph (1): 
(A) FOR LOWEST LEVEL OF INCOME.—In 
the case of an individual with income that does 
not exceed 133 percent of FPL, the individual 
shall be considered to have income that is 133 
percent of FPL. 
(B) APPLICATION OF HIGHER ACTUARIAL 
VALUE
PERCENTAGE
AT
TIER
TRANSITION 
POINTS.—If two actuarial value percentages 
may be determined with respect to an indi-
vidual, the actuarial value percentage shall be 
the higher of such percentages. 
(3) INDEXING.—For years after Y1, the Com-
missioner shall adjust the initial and final premium 
percentages to maintain the ratio of governmental to 
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(2) ADJUSTMENT.—The Commissioner shall ad-
just the maximum out-of-pocket limits under para-
graph (1) to ensure that such limits meet the actu-
arial value percentage specified in the table under 
section 343(d) for the income tier involved. 
(d) DETERMINATION AND PAYMENT OF COST-SHAR-
ING AFFORDABILITY CREDIT.—In the case of an afford-
able credit eligible individual in a tier enrolled in an Ex-
change-participating health benefits plan offered by a 
QHBP offering entity, the Commissioner shall provide for 
payment to the offering entity of an amount equivalent 
to the increased actuarial value of the benefits under the 
plan provided under section 303(c)(2)(B) resulting from 
the reduction in cost-sharing described in subsections (b) 
and (c). 
SEC. 345. INCOME DETERMINATIONS. 
(a) IN GENERAL.—In applying this subtitle for an 
affordability credit for an individual for a plan year, the 
individual’s income shall be the income (as defined in sec-
tion 342(c)) for the individual for the most recent taxable 
year (as determined in accordance with rules of the Com-
missioner). The Federal poverty level applied shall be such 
level in effect as of the date of the application. 
(b) PROGRAM INTEGRITY; INCOME VERIFICATION 
PROCEDURES.— 
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(1) PROGRAM INTEGRITY.—The Commissioner 
shall take such steps as may be appropriate to en-
sure the accuracy of determinations and redeter-
minations under this subtitle. 
(2) INCOME VERIFICATION.— 
(A) IN GENERAL.—Upon an initial applica-
tion of an individual for an affordability credit 
under this subtitle (or in applying section 
342(b)) or upon an application for a change in 
the affordability credit based upon a significant 
change in modified adjusted gross income de-
scribed in subsection (c)(1)— 
(i) the Commissioner shall request 
from the Secretary of the Treasury the dis-
closure to the Commissioner of such infor-
mation as may be permitted to verify the 
information contained in such application; 
and 
(ii) the Commissioner shall use the in-
formation so disclosed to verify such infor-
mation. 
(B) 
ALTERNATIVE
PROCEDURES.—The 
Commissioner shall establish procedures for the 
verification of income for purposes of this sub-
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257 
title if no income tax return is available for the 
most recent completed tax year. 
(c) SPECIAL RULES.— 
(1) CHANGES IN INCOME AS A PERCENT OF 
FPL.—In the case that an individual’s income (ex-
pressed as a percentage of the Federal poverty level 
for a family of the size involved) for a plan year is 
expected (in a manner specified by the Commis-
sioner) to be significantly different from the income 
(as so expressed) used under subsection (a), the 
Commissioner shall establish rules requiring an indi-
vidual to report, consistent with the mechanism es-
tablished under paragraph (2), significant changes 
in such income (including a significant change in 
family composition) to the Commissioner and requir-
ing the substitution of such income for the income 
otherwise applicable. 
(2) REPORTING OF SIGNIFICANT CHANGES IN 
INCOME.—The Commissioner shall establish rules 
under which an individual determined to be an af-
fordable credit eligible individual would be required 
to inform the Commissioner when there is a signifi-
cant change in the modified adjusted gross income 
of the individual (expressed as a percentage of the 
FPL for a family of the size involved) and of the in-
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formation regarding such change. Such mechanism 
shall provide for guidelines that specify the cir-
cumstances that qualify as a significant change, the 
verifiable information required to document such a 
change, and the process for submission of such in-
formation. If the Commissioner receives new infor-
mation from an individual regarding the modified 
adjusted gross income of the individual, the Commis-
sioner shall provide for a redetermination of the in-
dividual’s eligibility to be an affordable credit eligible 
individual. 
(3) TRANSITION FOR CHIP.—In the case of a 
child described in section 302(d)(2), the Commis-
sioner shall establish rules under which the modified 
adjusted gross income of the child is deemed to be 
no greater than the family income of the child as 
most recently determined before Y1 by the State 
under title XXI of the Social Security Act. 
(4) STUDY OF GEOGRAPHIC VARIATION IN AP-
PLICATION OF FPL.— 
(A) 
IN
GENERAL.—The 
Secretary 
of 
Health and Human Services shall conduct a 
study to examine the feasibility and implication 
of adjusting the application of the Federal pov-
erty level under this subtitle for different geo-
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259 
graphic areas so as to reflect the variations in 
cost-of-living among different areas within the 
United States. If the Secretary determines that 
an adjustment is feasible, the study should in-
clude a methodology to make such an adjust-
ment. Not later than the first day of Y1, the 
Secretary shall submit to Congress a report on 
such study and shall include such recommenda-
tions as the Secretary determines appropriate. 
(B) INCLUSION OF TERRITORIES.— 
(i) IN GENERAL.—The Secretary shall 
ensure that the study under subparagraph 
(A) covers the territories of the United 
States and that special attention is paid to 
the disparity that exists among poverty lev-
els and the cost of living in such territories 
and to the impact of such disparity on ef-
forts to expand health coverage and ensure 
health care. 
(ii) TERRITORIES DEFINED.—In this 
subparagraph, the term ‘‘territories of the 
United States’’ includes the Common-
wealth of Puerto Rico, the United States 
Virgin Islands, Guam, the Northern Mar-
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