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.
[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5610 Introduced in House (IH)]
<DOC>
117th CONGRESS
1st Session
H. R. 5610
To streamline enrollment in health insurance affordability programs and
minimum essential coverage, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 19, 2021
Mr. Bera introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committee on
Ways and Means, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To streamline enrollment in health insurance affordability programs and
minimum essential coverage, and for other purposes.
Be it enacted by the Senate and House of 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>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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