HSB 741 (LSB 6367YC (1) 90)

HOUSE FILE _____ 

BY  (PROPOSED COMMITTEE ON WAYS AND MEANS BILL BY CHAIRPERSON KAUFMANN)

A BILL FOR

An Act relating to the establishment of an easy enrollment health care coverage program utilizing the state income tax form.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  422.12P  Income tax form —— easy enrollment health care coverage program.
   1.  The department, in cooperation with the department of health and human services and the insurance division, shall establish an easy enrollment health care coverage program utilizing the state income tax form to identify residents of the state who are uninsured but may qualify for benefits under a health care coverage program. The easy enrollment health care coverage program shall be designed to do all of the following:
   a.  Facilitate identification of taxpayers and members of taxpayers’ households who are uninsured.
   b.  Provide taxpayers with a method to authorize the department to share insurance-relevant information with the Iowa health insurance marketplace and the department of health and human services for the purpose of assessing eligibility for a health care coverage program.
   c.  Provide for automatic enrollment or provisionally assessed eligibility of the taxpayer or a member of the taxpayer’s household in the Medicaid program or other health care coverage program.
   d.  Facilitate enrollment in a health care coverage program.
   2.  For the tax year beginning January 1, 2024, the director or the director’s designee shall develop the income tax form to include all of the following options for a taxpayer who files an individual or joint income tax return with the department under section 422.13:
   a.  A check box indicting that the taxpayer filing the tax return either has or does not have health care coverage.
   b.  A check box indicating that the spouse of the taxpayer filing the tax return either has or does not have health care coverage.
   c.  A check box indicating each dependent of the taxpayer who does not have health care coverage, and a space to indicate the birth date of each such dependent.
   d.  A check box indicating each member of the taxpayer’s household who is not the spouse of the taxpayer or a dependent of the taxpayer, the individual’s relationship to the taxpayer, the individual’s birth date, and whether the individual has health care coverage.
   e.  A check box authorizing the department to share insurance-relevant information with the Iowa health insurance marketplace and the department of health and human services.
   f.  A check box authorizing the department of health and human services to enroll the taxpayer or a member of the taxpayer’s household in the Medicaid program if the department of health and human services has sufficient insurance-relevant information to complete an eligibility determination for the taxpayer or a member of the taxpayer’s household, but only if the taxpayer or the member of the taxpayer’s household will not be subject to any cost including deductibles or copayments for such health care coverage.
   g.  An email address, telephone number, or other preferred method of communicating with the taxpayer for additional contact by the Iowa health insurance marketplace or the department of health and human services.
   3.  If a taxpayer indicates on the income tax form that the taxpayer or anyone in the taxpayer’s household does not have health care coverage, and the taxpayer authorizes the department to share the taxpayer’s insurance-relevant information with the Iowa health insurance marketplace and the department of health and human services, the department shall forward to the Iowa health insurance marketplace and to the department of health and human services the taxpayer’s insurance-relevant information and a copy of the taxpayer’s authorization.
   4.  a.  Upon receiving a taxpayer’s insurance-relevant information and authorization from the department under this section, the Iowa health insurance marketplace and the department of health and human services shall assess the taxpayer’s eligibility or the eligibility of the members of the taxpayer’s household for a health care coverage program.
   b.  (1)  Following the assessment, if the department of health and human services has sufficient insurance-relevant information to determine the taxpayer or a member of the taxpayer’s household is eligible for the Medicaid program, the department shall do one of the following:
   (a)  If the taxpayer authorized such enrollment, enroll the eligible taxpayer or eligible member of the taxpayer’s household in the Medicaid program.
   (b)  If the taxpayer did not authorize such enrollment in the Medicaid program, contact the taxpayer and provide the taxpayer with information on the Medicaid program.
   (2)  Following the assessment, if the department of health and human services has sufficient insurance-relevant information to determine the taxpayer or a member of the taxpayer’s household is not eligible for the Medicaid program but may be eligible for other health care coverage programs under the purview of the department, contact the taxpayer to provide the taxpayer with information about the other health care coverage program options including specific benefits and cost-sharing requirements, enrollment instructions, and enrollment assistance.
   (3)  Following the assessment, if the department of health and human services does not have sufficient insurance-relevant information to determine if the taxpayer or a member of the taxpayer’s household is eligible for the Medicaid program or other health care coverage programs under the purview of the department, contact the taxpayer to obtain sufficient information to make a determination.
   c.  Following the assessment, if the Iowa health insurance marketplace determines the taxpayer or a member of the taxpayer’s household may be eligible for a qualified health plan or financial assistance through the Iowa health insurance marketplace, the Iowa health insurance marketplace shall contact the taxpayer and provide the taxpayer with information on all of the following:
   (1)  Qualified health plans available to the taxpayer or a member of the taxpayer’s household through the Iowa health insurance marketplace.
   (2)  Specific enrollment instructions and information on enrollment assistance for each of the qualified health plans available to the taxpayer or a member of the taxpayer’s household.
   (3)  Information on the federal premium assistance credit provided pursuant to 26 U.S.C. §36B.
   5.  Notwithstanding any state confidentiality or privacy protection or other provision of law to the contrary, the department may share confidential tax return information with the department of health and human services and the Iowa health insurance marketplace to the extent the confidential tax return information constitutes insurance-relevant information and the department has received the taxpayer’s consent to share the information.
   6.  The provision of information by a taxpayer under this section is voluntary and a taxpayer shall not be subject to a penalty for not providing the information specified under this section.
   7.  The department, the department of health and human services, and the insurance division shall collaboratively do all of the following:
   a.  Develop the instructions for completion of the income tax return form and compile other information to accompany the income tax form provided to taxpayers under this section.
   b.  Define terms for the purposes of both completion of the income tax form and for information about and eligibility for health care coverage programs including the terms “dependent” and “household”.
   c.  Develop outreach educational materials and programming to communicate the availability and the purpose of the easy enrollment health care coverage program to the public. The materials and programming shall include materials developed for different target groups, including but not limited to in-person and online tax preparers, consumer assistance organizations, community groups, and underserved groups.
   d.  Enter into any data-sharing agreements necessary to facilitate insurance-relevant information sharing and tracking, eligibility verification procedures, and outreach efforts.
   e.  Consider criteria for automatic exclusions such as taxpayers who do not reside in the state.
   f.  Notify and provide training for both in-person tax preparers and electronic tax preparation programs regarding the changes to the tax forms to facilitate software updates and compliance.
   g.  Automate the tracking and response mechanisms to the greatest extent possible.
   h.  Develop and utilize any other processes or procedures that facilitate the easy enrollment health care coverage program.
   8.  Beginning January 15, 2026, and annually thereafter, the department, the department of health and human services, and the insurance division shall collaboratively report to the governor and the general assembly all of the following information based on the immediately preceding calendar year’s tax return data:
   a.  The number of taxpayers who indicated on their tax form that the taxpayer, the taxpayer’s spouse, a dependent of the taxpayer, or another household member of the taxpayer did not have health care coverage.
   b.  The number of taxpayers who authorized the sharing of insurance-relevant information for the purposes of assessing eligibility for a health care coverage program.
   c.  The number of taxpayers or members of a taxpayer’s household provisionally assessed as eligible for a health care coverage program.
   d.  The number of taxpayers or members of a taxpayer’s household who enrolled in a health care coverage program as the result of the easy enrollment health care coverage program, and the type of health care coverage program in which the person enrolled.
   e.  Demographic data on enrollment in specific health care coverage programs resulting from the easy enrollment health care coverage program.
   f.  Recommendations to improve outreach materials, address issues related to information required for establishing eligibility while maintaining confidentiality, and other proposed changes to improve the easy enrollment health care coverage program.
   9.  The department, the department of health and human services, and the insurance division shall each adopt rules pursuant to chapter 17A to jointly implement and administer the easy enrollment health care coverage program under this section.
   10.  As used in this section:
   a.  “Affordable Care Act” means the federal Patient Protection and Affordable Care Act, Pub. L. No. 111-148, as amended by the federal Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, and any amendments thereto.
   b.  “Health care coverage program” means the Medicaid program, the healthy and well kids in Iowa program, the Iowa health and wellness plan, or a qualified health plan available through the Iowa health insurance marketplace.
   c.  “Healthy and well kids in Iowa program” or “Hawki program” means the Hawki program as defined in section 514I.2.
   d.  “Household” means the spouse, any dependent, and any other individual who resides with the taxpayer but is not claimed as a spouse or dependent on the taxpayer’s income tax return.
   e.  “Insurance division” means the insurance division of the department of insurance and financial services.
   f.  “Insurance-relevant information” means information pertaining to the insurance enrollment status of a taxpayer or members of a taxpayer’s household and that is derived or obtained from the taxpayer’s state income tax return; provided that information is limited to information necessary to assess the eligibility of the taxpayer or members of the taxpayer’s household for health coverage programs and includes:
   (1)  Adjusted gross income and other types of reported income used to assess eligibility for a health coverage program.
   (2)  Household size.
   (3)  Claimed dependents.
   (4)  Contact information and personally identifying information necessary to assess health coverage program eligibility and used to match against relevant third-party data sources.
   (5)  Any other information necessary to determine eligibility for a health care coverage program as specified by rule of the department, in consultation with the department of health and human services and the insurance division.
   g.  “Iowa health and wellness plan” means the Iowa health and wellness plan established in chapter 249N.
   h.  “Iowa health insurance marketplace” means the American health benefits exchange created pursuant to the Affordable Care Act.
   i.  “Medicaid program” means the same as defined in section 249A.2.
   j.  “Qualified health plan” means an insurance plan that is certified by the Iowa health insurance marketplace, provides essential health benefits, follows established limits on cost-sharing including for deductibles, copayments, and out-of-pocket maximum amounts, and meets other requirements under the Affordable Care Act.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill establishes an easy enrollment health care coverage program. The bill requires the department of revenue (DOR) in cooperation with the department of health and human services (HHS) and the insurance division of the department of insurance and financial services (insurance division) to establish an easy enrollment health care coverage program (program) utilizing the state income tax form to identify residents of the state who are uninsured but may qualify for benefits under a health care coverage program. The program is designed to facilitate identification of taxpayers and members of taxpayers’ households who are uninsured; provide taxpayers with a method to authorize the sharing of insurance-relevant information for the purpose of assessing eligibility for a health care coverage program; provide for automatic enrollment or provisionally assessed eligibility of the taxpayer or a member of the taxpayer’s household in the Medicaid program or other health care coverage program; and facilitate enrollment in a health care coverage program.
   For the tax year beginning January 1, 2024, the director of revenue (director), or the director’s designee shall develop the income tax form to include specific options for a taxpayer who files an individual or joint income tax return to indicate certain information, including that the taxpayer either does or does not have health care coverage, that the spouse of the taxpayer either does or does not have health care coverage, each of the dependents of the taxpayer who do not have health care coverage and their birth dates, information about other members of the taxpayer’s household including whether the individual does or does not have health care coverage, authorization for DOR to share insurance-relevant information with the Iowa health insurance marketplace (marketplace) and HHS; authorization for HHS to enroll the taxpayer or a member of the taxpayer’s household in the Medicaid program if HHS has sufficient insurance-relevant information to complete an eligibility determination; and the taxpayer’s contact information for their preferred method of communication.
   The bill provides alternative processes that the marketplace and HHS may follow depending on whether the taxpayer indicates the taxpayer or anyone in the taxpayer’s household does not have health care coverage, the taxpayer authorizes the sharing of the taxpayer’s insurance-relevant information, and the taxpayer’s insurance-relevant information and authorization are shared with the marketplace and HHS. Once the marketplace and HHS receive the taxpayer’s insurance-relevant information, the marketplace and HHS shall assess the taxpayer’s eligibility or the eligibility of the members of the taxpayer’s household for a health care coverage program. Following the assessment, if HHS has sufficient insurance-relevant information to determine the taxpayer or a member of the taxpayer’s household is eligible for the Medicaid program, and if the taxpayer authorized such enrollment, HHS shall enroll the eligible taxpayer or eligible member of the taxpayer’s household in the Medicaid program. If the taxpayer did not authorize such enrollment in the Medicaid program, HHS shall contact the taxpayer and provide the taxpayer with information on the Medicaid program. Following the assessment, if HHS has sufficient insurance-relevant information to determine the taxpayer or a member of the taxpayer’s household is not eligible for the Medicaid program but may be eligible for other health care coverage programs under the purview of HHS, HHS shall contact the taxpayer to provide the taxpayer with information about the other health care coverage program options, including specific benefits and cost-sharing requirements, enrollment instructions, and enrollment assistance. Following the assessment, if HHS does not have sufficient information to determine if the taxpayer or a member of the taxpayer’s household is eligible for the Medicaid program or another health care coverage program under the purview of the department, contact the taxpayer to obtain sufficient information to make a determination.
   Following the assessment, if the marketplace determines the taxpayer or a member of the taxpayer’s household may be eligible for a qualified health plan or financial assistance through the marketplace, the marketplace shall contact the taxpayer and provide the taxpayer with specific information about the qualified health plans available through the marketplace.
   The bill provides that notwithstanding any state confidentiality or privacy protection or other provision of law to the contrary, DOR may share confidential tax return information with HHS and the marketplace to the extent the confidential tax return information constitutes insurance-relevant information and DOR has received the taxpayer’s authorization to share the information.
   The provision of information by a taxpayer under the bill is voluntary and a taxpayer shall not be subject to a penalty for not providing the information.
   The bill requires DOR, HHS, and the insurance division to collaboratively develop the tax return form and accompanying information to be provided to taxpayers; develop outreach educational materials and programming to communicate the availability and the purpose of the program to the public; enter into any data-sharing agreements necessary to facilitate insurance-relevant information sharing and tracking, eligibility verification procedures, and outreach efforts; consider criteria for automatic exclusions such as taxpayers who do not reside in the state; notify and provide training for both in-person tax preparers and electronic tax preparation programs regarding the changes to the tax forms to facilitate software updates and compliance; automate the tracking and response mechanisms to the greatest extent possible; and develop and utilize any other processes or procedures that facilitate the program.
   Beginning January 15, 2026, and annually thereafter, DOR, HHS, and the insurance division shall collaboratively report specified information and recommendations to the governor and the general assembly based on the immediately preceding calendar year’s tax return data.
   DOR, HHS, and the insurance division shall each adopt administrative rules to jointly implement and administer the program.
   The bill provides definitions used in the bill.