Easy Enrollment in Health Care Act
Bill: H.R.5610 | Sponsor: Rep. Bera, Ami (D-CA)
Policy area: Health

Summary:
Easy Enrollment in Health Care Act
This bill revises the procedures related to enrollment in health insurance affordability programs, including Medicaid, the Children's Health Insurance Program (CHIP), and state-operated Basic Health Programs. The bill provides funding to support the changes.
Specifically, the bill permits individuals who do not have minimum essential coverage to, in conjunction with filing their tax return, determine whether any members of their household are eligible for an insurance affordability program and enroll in minimum essential coverage.
The bill makes individuals eligible for Medicaid or CHIP based on a prior finding of eligibility for the Temporary Assistance for Needy Families program or the Supplemental Nutrition Assistance Program. It also revises the continuous coverage standards under Medicaid and CHIP.
Additionally, the bill provides access to certain information to support enrollment in insurance affordability programs.

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 Representatives 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:
            (1) CHIP program.--The term ``CHIP program'' means a State 
        plan for child health assistance 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 ``household income'' has 
        the meaning given such term in section 36B(d) of the Internal 
        Revenue Code of 1986.
            (5) Household member.--The term ``household 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.
            (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 Patient 
                Protection and Affordable Care Act (42 U.S.C. 18001 et 
                seq.) for the enrollment in qualified health plans 
                offered through an Exchange, 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 Affordable Care Act (42 
                U.S.C. 18071), and the advance payment of such credits 
                and reductions under section 1412(a)(3) of the Patient 
                Protection 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 Affordable Care Act (42 
                U.S.C. 18051).
                    (E) Any other Federal, State, or local program that 
                provides assistance for some or all of the cost of 
                minimum essential coverage and requires eligibility for 
                such program to be based in whole or in part on income, 
                including such a program carried out through a waiver 
                under section 1332 of the Patient Protection and 
                Affordable 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 premium'', 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 an individual required 
                to enroll in such plan or coverage, after application 
                of the premium tax credit under section 36B of the 
                Internal Revenue Code of 1986, the advance payment of 
                such credit under section 1412(a)(3) of the Patient 
                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 described 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 respect to a taxpayer, any 
        return information, as defined 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 determination of, 
                the eligibility of any household member of the taxpayer 
                for any insurance affordability program, either 
                directly or through enabling access to additional 
                information potentially relevant to such eligibility; 
                or
                    (B) enrolling, or facilitating the enrollment of, 
                such individual in minimum essential coverage.
            (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 form of minimum essential 
        coverage, means a net premium of $0.00 for such plan coverage.

SEC. 3. FEDERAL INCOME TAX RETURNS USED TO FACILITATE ENROLLMENT INTO 
              INSURANCE AFFORDABILITY 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 coverage 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 affordability 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.
    (b) Taxpayer Requirements and Consent.--
            (1) In general.--Pursuant to the program established 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 whether to--
                            (i) in accordance with section 6103(l)(23) 
                        of the Internal Revenue Code of 1986 (as added 
                        by subsection (f)), consent to the disclosure 
                        and transfer to the applicable Exchange of any 
                        relevant return information for purposes of 
                        determining whether such household member may 
                        be eligible for any insurance affordability 
                        program and facilitating enrollment into such 
                        program and minimum essential coverage, 
                        including any further disclosure and transfer 
                        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 coverage that is available 
                        with a zero net premium, 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 
                                        coverage; or
                                            (bb) opt out of such 
                                        coverage that is available with 
                                        a zero net premium.
            (2) Establishment of options for taxpayer 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.--
                    (A) In general.--In the case of a taxpayer who has 
                consented to disclosure and transfer of relevant return 
                information pursuant to paragraph (1)(B)(i), such 
                taxpayer shall be enrolled in the insurance 
                affordability program only if the taxpayer submits a 
                supplemental form which is designed to collect 
                additional 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 include (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 described in 
                        section 1412(b)(2) of the Patient Protection 
                        and Affordable Care Act; (42 U.S.C. 
                        18082(b)(2)).
                            (v) Solely for the purpose of facilitating 
                        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 Secretary to disclose 
                        relevant return information for subsequent 
                        taxable years to insurance affordability 
                        programs.
                            (vi) Any methods preferred by the taxpayer 
                        or household member for the purpose of being 
                        contacted by the applicable Exchange or 
                        insurance affordability program with respect to 
                        any eligibility determination for, or 
                        enrollment in, an insurance affordability 
                        program or minimum essential coverage, such as 
                        an email address or a phone number for calls or 
                        text messages.
                            (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 Secretary 
                        of Health and Human Services, may require, 
                        including information requested on the single, 
                        streamlined application.
                    (B) Limitations.--The information obtained through 
                the form described in subparagraph (A) may not include 
                any request for information with respect to 
                citizenship, immigration status, or health status of 
                any household member.
                    (C) Additional information.--The form described in 
                subparagraph (A) and the accompanying tax instructions 
                may provide the taxpayer with additional information 
                about insurance affordability programs, including 
                information provided to applicants on the single, 
                streamlined application.
                    (D) Accessibility.--
                            (i) In general.--The Secretary shall ensure 
                        that the form described in subparagraph (A) is 
                        made available to all taxpayers without 
                        discrimination based on language, disability, 
                        literacy, or internet access.
                            (ii) Rule of construction.--Nothing in 
                        clause (i) shall be construed as diminishing, 
                        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 described 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 programs'' as ``free or 
        low-cost health insurance'').
    (c) Tax Return Preparers.--
            (1) In general.--With respect to any information submitted 
        in conjunction with a tax return solely for purposes of the 
        program described in subsection (a), any tax return preparer 
        involved in preparing the return containing such information 
        shall not be obligated to assess the accuracy of such 
        information as provided by the taxpayer.
            (2) Submission of information.--As part of the program 
        described in subsection (a), the Secretary shall establish 
        methods to allow for the immediate transfer of any relevant 
        return information to the applicable Exchange and insurance 
        affordability programs in order to increase the potential for 
        immediate determinations of eligibility for and enrollment in 
        insurance affordability programs and minimum essential 
        coverage.
    (d) Transfer of Information Through Secure Interface.--
            (1) In general.--As part of the program established under 
        subsection (a), the Secretary shall develop a secure, 
        electronic interface allowing an exchange of relevant return 
        information with the applicable Exchange in a manner similar to 
        the interface described in section 1413(c)(1) of the Patient 
        Protection 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 determination of eligibility for an insurance 
        affordability program or enrollment into minimum essential 
        coverage.
            (2) Transfer by treasury or tax preparers.--
                    (A) In general.--The interface described in 
                paragraph (1) shall allow, for any taxpayer who has 
                provided consent pursuant to subsection (b)(1)(B)(i), 
                for relevant return information, along with 
                confirmation that the Secretary 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 Secretary of Health 
                        and Human Services)--
                                    (I) if the Secretary is not able to 
                                transfer such information to the 
                                applicable 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 described 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 relevant return 
                information described in this subsection shall be 
                conducted--
                            (i) pursuant to interagency agreements that 
                        ensure data security and maintain 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 
                                household member for any insurance 
                                affordability program; and
                                    (II) enroll in minimum essential 
                                coverage.
    (e) Errors That Affect Eligibility for Insurance Affordability 
Programs.--The Secretary of Health and Human Services, in consultation 
with the Secretary, 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 affordability program than the assistance 
for which the individual 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 included in an amendment to the tax 
        return; and
            (2) correcting, as soon as practicable, the individual's 
        eligibility status for insurance affordability programs, 
        subject to, in the case of reduced eligibility for assistance, 
        any right of notice and appeal under laws governing the 
        applicable insurance affordability 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 Determining Eligibility 
for Insurance Affordability Programs and Enrollment Into Minimum 
Essential Health Coverage.--
            (1) In general.--Section 6103(l) of the Internal Revenue 
        Code of 1986 is amended by adding at the end the following:
            ``(23) Disclosure of return information for determining 
        eligibility for insurance affordability 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.--Return 
                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 information', `Exchange', 
                `insurance affordability program', and `minimum 
                essential coverage' have the same meanings given such 
                terms under section 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 inserting ``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 affordability 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 prescribed by the Secretary of Health and Human 
        Services, in consultation with the Secretary, through which, in 
        the case of an individual applying for an insurance 
        affordability program without filing a return of tax or 
        consenting to disclosure of relevant return information under 
        subsection (b)(1)(B)(i), the program determines household 
        income and family 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 ``Secretary'' means the 
Secretary of the Treasury, or the Secretary's delegate.

SEC. 4. EXCHANGE USE OF RELEVANT RETURN INFORMATION.

    (a) In General.--An Exchange that receives relevant 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 affordability 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 information 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 return, including 
                information obtained through data matching based on 
                social security numbers, 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 income, the Medicaid program, as 
        required under section 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 Patient Protection and 
        Affordable Care Act (42 U.S.C. 18081(f));
            (3) to the extent that any additional information 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 collection 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 taxpayer 
                        multiple times using the preferred contact 
                        methods described in section 3(b)(3)(A)(vi); 
                        and
                    (B) provides the individual with all procedural 
                protections that would otherwise be available 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 Medicaid program--
                    (A) enable such individual, through procedures 
                prescribed by the Secretary of Health and Human 
                Services, to seek coverage under the Medicaid program 
                or CHIP program by providing additional information 
                demonstrating potential eligibility for such program, 
                with any resulting determination subject to rights of 
                notice and appeal under laws governing insurance 
                affordability 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 Exchange 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 procedures and 
                business rules that the Exchange serving residents of 
                such State shall use in determining eligibility for the 
                State Medicaid program and CHIP program with respect to 
                individuals 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 
                categories and criteria for the Medicaid program and 
                CHIP program.
                    (B) Business rules.--The business rules described 
                in subparagraph (A) shall specify detailed eligibility 
                determination rules and procedures for processing 
                initial applications and renewals, 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 administrative 
                        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 described in 
                subparagraph (A) that does not select an option from 
                the set presented under such subparagraph within a 
                timeframe specified by the Secretary of Health and 
                Human Services, the Secretary of Health and Human 
                Services shall determine the option that the Exchange 
                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 individuals, 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 information 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 practicable, except as provided in 
                subparagraphs (B) and (D).
                    (B) Exception.--A State shall not enroll an 
                individual in coverage under the State Medicaid program 
                or CHIP program without the affirmative consent of the 
                individual if the individual would be required to pay a 
                premium for such coverage.
                    (C) Managed care.--If the State Medicaid program or 
                CHIP program requires an individual enrolled under 
                subparagraph (A) to receive coverage through a managed 
                care organization or entity, the State shall use a 
                procedure for assigning the individual to such an 
                organization or entity (including auto-assignment 
                procedures) 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.--Notwithstanding 
                subparagraph (A), an individual described in such 
                subparagraph shall be given one or more opportunities 
                to opt out of coverage under a State Medicaid program 
                or CHIP program, using procedures prescribed by the 
                Secretary of Health and Human Services.
    (c) Advance Premium Tax Credits for Qualified 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 section 3(b)(1)(B)(i), if the Exchange has 
        determined that an applicable household member has not 
        qualified for the Medicaid program or the CHIP program, 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, pursuant to 
                        section 1412 of the Patient Protection 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 election 
                        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 consent 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 accordance 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), based on the 
                        generosity of such plans' coverage of services 
                        not subject to a deductible.
                            (iii) Definition of highest actuarial 
                        value.--For purposes of this subparagraph, the 
                        term ``highest actuarial value'' means the 
                        highest actuarial value among--
                                    (I) the levels of coverage 
                                described in paragraph (1) of section 
                                1302(d) of the Patient Protection and 
                                Affordable Care Act (42 U.S.C. 
                                18022(d)), without regard to allowable 
                                variance under paragraph (3) of such 
                                section; and
                                    (II) as applicable, the levels of 
                                coverage that result from the 
                                application 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 enrollment.--As soon as 
                possible after an Exchange has identified a default 
                enrollment choice for an individual under subparagraph 
                (A)(ii), the Exchange 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 before 
                        the end of the special enrollment period under 
                        paragraph (1)(A) and to select a plan that best 
                        meets the needs of the individual and the 
                        individual's family;
                            (iii) an explanation that, if the 
                        individual 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 individual 
                        in such selected qualified health plan in 
                        accordance with subparagraph (E);
                            (iv) an explanation of the opt-out process 
                        preceding implementation of default enrollment, 
                        which shall meet standards prescribed by the 
                        Secretary of Health and Human Services; and
                            (v) information on options for assistance 
                        with enrollment and plan choice, including 
                        publicly funded navigators and private brokers 
                        and agents approved by the Exchange.
                    (E) Default enrollment.--
                            (i) In general.--Subject to subparagraph 
                        (F), an Exchange shall enroll in a default 
                        enrollment choice any individual who--
                                    (I) is sent a notice under 
                                subparagraph (D); and
                                    (II) fails to select a different 
                                qualified health plan, or opt out of 
                                default 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 enrolled, and explaining 
                        the reconsideration procedures described in 
                        subparagraph (F).
                    (F) Reconsideration.--
                            (i) In general.--Not later than 30 days 
                        after receiving a notice under subparagraph 
                        (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 qualified 
                                health plan under such subparagraph is 
                                a high cost-sharing qualified health 
                                plan, the individual's decision to 
                                enroll in a specified lower cost-
                                sharing qualified health plan, 
                                identified by the Exchange, that is 
                                offered by the same health insurance 
                                issuer that sponsors the qualified 
                                health plan that was selected under 
                                such subparagraph.
                            (ii) Definitions.--For purposes of this 
                        subparagraph:
                                    (I) High cost-sharing qualified 
                                health plan.--The term ``high cost-
                                sharing qualified health plan'' means--
                                            (aa) in the case of a 
                                        household member with a 
                                        household income at or below 
                                        200 percent of the poverty 
                                        line, a qualified health plan 
                                        that is not at the silver 
                                        level; or
                                            (bb) in the case of a 
                                        household 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.--The term 
                                ``specified lower cost-sharing 
                                qualified health plan'' means--
                                            (aa) in the case of a 
                                        household member with a 
                                        household income at or below 
                                        200 percent of the poverty 
                                        line, the lowest-premium 
                                        qualified health plan offered 
                                        by the health insurance issuer 
                                        that is at the silver level; or
                                            (bb) in the case of a 
                                        household 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 INSURANCE AFFORDABILITY 
              PROGRAMS.

    (a) Improving the Stability and Predictability of Medicaid and CHIP 
Coverage.--
            (1) In general.--Section 1902(e) of the Social Security Act 
        (42 U.S.C. 1396a(e)) is amended by striking paragraph (12) and 
        inserting the following:
            ``(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 exceed 19 years of age) and who is 
                determined to be eligible for benefits under a State 
                plan approved under this title under subsection 
                (a)(10)(A) shall remain eligible for those benefits 
                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 exceeds 
                        that age.
                    ``(B) Continuous coverage for certain eligible 
                individuals subject to modified adjusted gross income 
                criteria.--
                            ``(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 modified 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 continuous 
                        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 flexibility.--A State 
                shall ensure that, notwithstanding the application of a 
                continuous coverage period under this paragraph, an 
                individual who is enrolled under the State plan (or 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 individual 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 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 residence. A State shall rely on 
                                such a finding both for the initial 
                                determination of eligibility for 
                                medical assistance under the plan or 
                                waiver and any subsequent 
                                redetermination of eligibility.
                                    ``(II) Findings described.--A 
                                finding described in this subclause is 
                                a determination made within a 
                                reasonable period (as determined by the 
                                Secretary) by a State agency 
                                responsible for administering the 
                                Temporary Assistance for Needy Families 
                                program under part A of title IV or the 
                                Supplemental Nutrition Assistance 
                                Program established under the Food and 
                                Nutrition Act of 2008 that an 
                                individual is eligible for benefits 
                                under such program.
                                    ``(III) Limitation.--A State shall 
                                be required to 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 only in the case 
                                of--
                                            ``(aa) an individual who is 
                                        under 19 years of age; or
                                            ``(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 subclause 
                                (III).
                            ``(vii) Recent annual income establishing 
                        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 adjusted 
                                gross income under subparagraph (A), a 
                                State shall provide that an individual 
                                whose eligibility date occurs in 
                                January, February, March, or April of a 
                                calendar year shall be financially 
                                eligible if the individual's modified 
                                adjusted gross income for the preceding 
                                calendar year satisfies the income 
                                eligibility requirement applicable to 
                                the individual.
                                    ``(II) Definition.--For purposes of 
                                this clause, an `eligibility date' 
                                means--
                                            ``(aa) in the case of an 
                                        individual who is not receiving 
                                        medical assistance when the 
                                        individual applies for an 
                                        insurance affordability program 
                                        (as defined in section 2 of the 
                                        Easy Enrollment 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 
                                        individual who is receiving 
                                        medical assistance and whose 
                                        continued eligibility for such 
                                        assistance is being 
                                        redetermined, the date on which 
                                        the individual is determined to 
                                        satisfy all eligibility 
                                        requirements applicable to the 
                                        individual other than income 
                                        eligibility.
                                    ``(III) Rules of construction.--
                                            ``(aa) Eligibility 
                                        determinations during may 
                                        through december.--Nothing in 
                                        subclause (I) shall be 
                                        construed as diminishing, 
                                        reducing, or otherwise limiting 
                                        the State's obligation to grant 
                                        eligibility, under 
                                        circumstances other than those 
                                        described in such subclause, 
                                        based on data that include 
                                        income shown on an individual'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, 
                                        reducing, or otherwise limiting 
                                        grounds for eligibility other 
                                        than those described in such 
                                        subclause, including 
                                        eligibility based on income as 
                                        of the point in time at which 
                                        an application for medical 
                                        assistance under the State plan 
                                        or a waiver of the plan is 
                                        processed.
                                            ``(cc) Qualifying for 
                                        additional assistance.--
                                        Notwithstanding 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 application 
                                        for medical assistance is 
                                        processed or, in the case of 
                                        redetermination of eligibility, 
                                        projected annual income, to 
                                        determine the individual's 
                                        eligibility for medical 
                                        assistance if using the 
                                        individual's modified adjusted 
                                        gross income, as so determined, 
                                        would result in the individual 
                                        being eligible for greater 
                                        benefits under the State plan 
                                        (or a waiver of such plan) or 
                                        in the imposition of lower 
                                        premiums or cost-sharing on the 
                                        individual under the plan (or 
                                        waiver) than if the 
                                        individual'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.--Section 36B of the 
        Internal Revenue Code of 1986 is amended--
                    (A) in subsection (b)--
                            (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 ``applicable taxable 
                                        year'', and
                                            (bb) in clause (ii)(I), by 
                                        inserting ``(or, in the case of 
                                        applicable 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 applicable 
                                                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 ``applicable 
                                taxable year'', and
                                    (II) in subparagraph (D), by 
                                striking ``is allowable'' and all that 
                                follows through the period and 
                                inserting ``was allowable to another 
                                taxpayer for the applicable taxable 
                                year.'',
                            (ii) in paragraph (2)(C), by adding at the 
                        end the following:
                            ``(v) Time period.--
                                    ``(I) In general.--Except as 
                                provided under subclause (II), 
                                eligibility for minimum essential 
                                coverage under this subparagraph shall 
                                be based on the individual's 
                                eligibility for employer-sponsored 
                                minimum essential coverage during the 
                                open enrollment period (or during a 
                                special enrollment period for an 
                                individual who enrolls or who changes 
                                their qualified health plan during a 
                                special enrollment period), as 
                                determined by the applicable Exchange.
                                    ``(II) Exception.--An individual 
                                shall be considered eligible for 
                                minimum essential coverage under clause 
                                (iii) for a month for which such 
                                Exchange has determined, subject to 
                                rights of notice and appeal under laws 
                                governing the applicable insurance 
                                affordability program (including 
                                section 1411(f) of the Patient 
                                Protection and Affordable Care Act (42 
                                U.S.C. 18081(f))), that the individual 
                                is covered by an eligible employer-
                                sponsored plan.'', and
                            (iii) by adding at the end the following:
            ``(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 recent 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)--
                            (i) in paragraph (1)--
                                    (I) by striking ``is allowed'' and 
                                inserting ``was allowed'', and
                                    (II) by inserting ``applicable'' 
                                before ``taxable year'',
                            (ii) in paragraph (3)(B), by inserting 
                        ``applicable'' before ``taxable year'',
                    (D) in subsection (e)(1)--
                            (i) by striking ``is allowed'' and 
                        inserting ``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 following:
                    ``(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--
                                    ``(I) as shown on the return of tax 
                                for the applicable plan year, provided 
                                such return was accepted by the 
                                Secretary as meeting applicable 
                                processing criteria, or
                                    ``(II) as determined by the 
                                applicable 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 coverage under subsection 
                        (c)(2)(C) if the applicable Exchange--
                                    ``(I) determined, under clause 
                                (v)(I) of such subsection, that the 
                                individual was ineligible for employer-
                                sponsored minimum essential coverage, 
                                and
                                    ``(II) did not determine, under 
                                clause (v)(II) of such subsection, that 
                                the individual was covered through 
                                employer-sponsored minimum essential 
                                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 taxpayer 
                        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 Protection 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.'';
                    (B) in paragraph (2)(B), by striking ``second 
                preceding taxable year'' and inserting ``applicable 
                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 experiences 
        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 
        Internal 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 assistance.--
                    ``(A) In general.--The Secretary, in consultation 
                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; 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 additional 
                        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 determines 
                        an individual has experienced substantial 
                        changes in circumstances as described in clause 
                        (i), the Exchange conveys such determination to 
                        the Secretary of the Treasury under section 
                        36B(f) of the Internal 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 determines 
                        an individual has experienced substantial 
                        changes in circumstances described in clause 
                        (i), the individual may qualify without delay 
                        for additional advance premium tax credits 
                        under section 36B of the Internal Revenue Code 
                        of 1986, increased cost-sharing reductions 
                        under section 1402, additional basic health 
                        program assistance 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 ELIGIBILITY 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 paragraphs:
            ``(5) Administration of insurance affordability programs.--
                    ``(A) In general.--The Secretary shall provide 
                access to insurance affordability programs (as such 
                term is defined in section 2 of the Easy Enrollment in 
                Health Care Act) to information in the National 
                Directory of New Hires that involves--
                            ``(i) identity, employer, quarterly wages, 
                        and unemployment compensation, to the extent 
                        such information is potentially 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 
                        information is potentially relevant to 
                        determining 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 reimburse the Secretary, 
                in accordance with subsection (k)(3), for the 
                additional costs incurred by the Secretary in 
                furnishing information under this paragraph.''.
    (b) Use of Information From the National Directory of New Hires.--
Notwithstanding any other provision of law--
            (1) in determining an individual's eligibility for advance 
        payment of premium tax credits under section 1412(a)(3) of the 
        Patient Protection and Affordable 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 Affordable Care Act (42 U.S.C. 18051), 
        an Exchange may use information about identity, employer, 
        quarterly wages, and unemployment compensation in the National 
        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 
        notice and appeal rights for any resulting eligibility 
        determination, 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 New Hires about identity, 
        employer, quarterly wages, and unemployment compensation to 
        determine eligibility and to implement third-party liability 
        procedures or premium assistance programs otherwise 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.--Notwithstanding any other provision of Federal or 
State law:
            (1) In general.--Subject to the requirements described in 
        paragraph (2), for purposes of determining eligibility and, in 
        the case of a Medicaid program, for purposes of determining the 
        applicability of third-party liability procedures or premium 
        assistance policies otherwise permitted or mandated under 
        Federal law, an insurance affordability program shall have 
        access to any source of information, maintained by or 
        accessible to a public entity, about receipt or offers of 
        coverage through a group health plan, as defined in section 2 
        of the Easy Enrollment in Health Care Act. Such sources shall 
        include--
                    (A) information maintained by or accessible 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 accessible 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 affordability program shall 
        obtain the information described in paragraph (1) pursuant to 
        an interagency or other agreement, consistent with standards 
        prescribed by the Secretary of Health and Human Services, in 
        consultation with the Secretary, that prevents the unauthorized 
        use, disclosure, or modification of such information and 
        otherwise protects privacy and data security.
    (d) Authorization To Receive Relevant Information.--
            (1) In general.--Notwithstanding any other provision of 
        law, a Federal or State agency or private entity in possession 
        of the sources of data potentially relevant to eligibility for 
        an insurance affordability 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 penalties.--A 
        conveyance of data to an insurance affordability 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 violation 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--
            (1) with respect to verifying an element of eligibility 
        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 individual must 
        verify such information, provide an attestation as to the 
        subject of such information, or provide a signature for 
        attestations that include that subject, before the individual 
        is enrolled into minimum essential coverage; and
            (2) satisfy any otherwise applicable signature requirement 
        with respect to an individual's enrollment 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 section shall be 
construed as diminishing, reducing, or otherwise limiting the legal 
authority for an insurance affordability program to grant eligibility, 
in whole or in part, based on an attestation alone, without requiring 
verification through data matches or other sources.

SEC. 7. FUNDING FOR INFORMATION TECHNOLOGY DEVELOPMENT 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 
exchange 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 
described 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.
            (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 described in subsection (b) to request a 
transfer of funding from the amounts appropriated under subsection (a), 
including 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 disclosure 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)--
                    (A) in paragraph (1)(A), by striking ``The State 
                shall require'' and inserting ``Subject to paragraph 
                (6), the State shall require''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(6) Satisfaction of requirement through reliable data 
        matches.--In the case of an individual applying for the program 
        described in paragraph (2) or the Children's Health Insurance 
        Program under title XXI of this Act, the program shall not 
        require an individual to make the declaration described in 
        paragraph (1)(A) if the procedures established pursuant to 
        section 3(a)(1) of the Easy Enrollment in Health Care Act or 
        section 1413(c)(2)(B)(ii)(II) of the Patient Protection and 
        Affordable Care Act (42 U.S.C. 18083(c)(2)(B)(ii)(II)) were 
        used to verify the individual's citizenship, based on the 
        individual's social security number as well as other 
        identifying information, which may include such facts as name 
        and date of birth, that increases the accuracy of matches with 
        applicable sources of citizenship data.''.
    (b) Eligibility Determinations Under PPACA.--Section 1411(b) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 18081(b)) is 
amended--
            (1) in paragraph (3), by striking subparagraph (A) and 
        inserting the following:
                    ``(A) Information regarding income and family 
                size.--The information described in paragraphs (21) and 
                (23) of section 6103(l) of the Internal Revenue Code of 
                1986 for the applicable tax year, as defined in section 
                36B(c)(5) of such Code.''; and
            (2) by adding at the end the following:
            ``(6) Receipt of information.--The requirements for 
        providing information under this subsection may be satisfied 
        through data submitted to the Exchange through reliable data 
        matches, rather than by the applicant providing information. In 
        the case described in paragraph (2)(A), data matches shall not 
        be used for this purpose unless they meet the requirements 
        described in section 1137(b)(6) of the Social Security Act (42 
        U.S.C. 1320b-7(b)(6)).''.

SEC. 9. ADVISORY COMMITTEE.

    (a) In General.--The Secretary of the Treasury, in conjunction with 
the Secretary of Health and Human Services, shall establish an advisory 
committee to provide guidance to both Secretaries in carrying out this 
Act. The members of the committee shall include--
            (1) national experts in behavioral economics, other 
        behavioral science, insurance affordability programs, 
        enrollment and retention in health programs and other benefit 
        programs, public benefits for immigrants, public benefits for 
        other historically marginalized or disadvantaged communities, 
        and Federal income tax policy and operations; and
            (2) representatives of all relevant stakeholders, 
        including--
                    (A) consumers;
                    (B) health insurance issuers;
                    (C) health care providers; and
                    (D) tax return preparers.
    (b) Purview.--The advisory committee established under subsection 
(a) shall be solicited for advice on any topic chosen by the Secretary 
of the Treasury or the Secretary of Health and Human Services, 
including (at a minimum) all matters as to which a provision in this 
Act, other than subsection (a), requires a consultation between the 
Secretary of the Treasury and the Secretary of Health and Human 
Services.

SEC. 10. STUDY.

    (a) In General.--The Secretary of Health and Human Services shall 
conduct a study analyzing the impact of this Act and making 
recommendations for--
            (1) State pilot projects to test improvements to this Act, 
        including an analysis of policies that automatically enroll 
        eligible individuals into group health plans;
            (2) modifying open enrollment periods for exchanges and 
        plan years so that open enrollment coincides with filing of 
        Federal income tax returns; and
            (3) other steps to improve outcomes achieved by this Act.
    (b) Report.--Not later than July 1, 2026, the Secretary of Health 
and Human Services shall deliver a report on the study and 
recommendations under subsection (a) to the Committee on Ways and 
Means, the Committee on Education and Labor, and the Committee on 
Energy and Commerce of the House of Representatives and to the 
Committee on Finance and the Committee on Health, Education, Labor, and 
Pensions of the Senate.

SEC. 11. APPROPRIATIONS.

    Out of amounts in the Treasury not otherwise appropriated, there 
are appropriated, in addition to the amounts described in section 7 and 
any amounts otherwise made available, to carry out the purposes of this 
Act, such sums as may be necessary to the Secretary of the Treasury, 
and such sums as may be necessary to the Secretary of Health and Human 
Services, to remain available until expended.
                                 <all>