House File 355 - Introduced HOUSE FILE 355 BY ZABNER A BILL FOR An Act relating to the establishment of an easy enrollment 1 health care coverage program utilizing the state income tax 2 form. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 2186YH (2) 91 jm/jh
H.F. 355 Section 1. NEW SECTION . 422.12Q Income tax form easy 1 enrollment health care coverage program. 2 1. The department, in cooperation with the department of 3 health and human services and the insurance division, shall 4 establish an easy enrollment health care coverage program 5 utilizing the state income tax form to identify residents 6 of the state who are uninsured but may qualify for benefits 7 under a health care coverage program. The easy enrollment 8 health care coverage program shall be designed to do all of the 9 following: 10 a. Facilitate identification of taxpayers and members of 11 taxpayers households who are uninsured. 12 b. Provide taxpayers with a method to authorize the 13 department to share insurance-relevant information with the 14 Iowa health insurance marketplace and the department of health 15 and human services for the purpose of assessing eligibility for 16 a health care coverage program. 17 c. Provide for automatic enrollment or provisionally 18 assessed eligibility of the taxpayer or a member of the 19 taxpayers household in the Medicaid program or other health 20 care coverage program. 21 d. Facilitate enrollment in a health care coverage program. 22 2. For the tax year beginning January 1, 2025, the director 23 or the directors designee shall develop the income tax form to 24 include all of the following options for a taxpayer who files 25 an individual or joint income tax return with the department 26 under section 422.13: 27 a. A check box indicting that the taxpayer filing the tax 28 return either has or does not have health care coverage. 29 b. A check box indicating that the spouse of the taxpayer 30 filing the tax return either has or does not have health care 31 coverage. 32 c. A check box indicating each dependent of the taxpayer who 33 does not have health care coverage, and a space to indicate the 34 birth date of each such dependent. 35 -1- LSB 2186YH (2) 91 jm/jh 1/ 11
H.F. 355 d. A check box indicating each member of the taxpayers 1 household who is not the spouse of the taxpayer or a dependent 2 of the taxpayer, the individuals relationship to the taxpayer, 3 the individuals birth date, and whether the individual has 4 health care coverage. 5 e. A check box authorizing the department to share 6 insurance-relevant information with the Iowa health insurance 7 marketplace and the department of health and human services. 8 f. A check box authorizing the department of health and 9 human services to enroll the taxpayer or a member of the 10 taxpayers household in the Medicaid program if the department 11 of health and human services has sufficient insurance-relevant 12 information to complete an eligibility determination for the 13 taxpayer or a member of the taxpayers household, but only if 14 the taxpayer or the member of the taxpayers household will not 15 be subject to any cost including deductibles or copayments for 16 such health care coverage. 17 g. An email address, telephone number, or other preferred 18 method of communicating with the taxpayer for additional 19 contact by the Iowa health insurance marketplace or the 20 department of health and human services. 21 3. If a taxpayer indicates on the income tax form that 22 the taxpayer or anyone in the taxpayers household does 23 not have health care coverage, and the taxpayer authorizes 24 the department to share the taxpayers insurance-relevant 25 information with the Iowa health insurance marketplace and 26 the department of health and human services, the department 27 shall forward to the Iowa health insurance marketplace and to 28 the department of health and human services the taxpayers 29 insurance-relevant information and a copy of the taxpayers 30 authorization. 31 4. a. Upon receiving a taxpayers insurance-relevant 32 information and authorization from the department under 33 this section, the Iowa health insurance marketplace and the 34 department of health and human services shall assess the 35 -2- LSB 2186YH (2) 91 jm/jh 2/ 11
H.F. 355 taxpayers eligibility or the eligibility of the members of the 1 taxpayers household for a health care coverage program. 2 b. (1) Following the assessment, if the department of 3 health and human services has sufficient insurance-relevant 4 information to determine the taxpayer or a member of the 5 taxpayers household is eligible for the Medicaid program, the 6 department shall do one of the following: 7 (a) If the taxpayer authorized such enrollment, enroll 8 the eligible taxpayer or eligible member of the taxpayers 9 household in the Medicaid program. 10 (b) If the taxpayer did not authorize such enrollment in the 11 Medicaid program, contact the taxpayer and provide the taxpayer 12 with information on the Medicaid program. 13 (2) Following the assessment, if the department of 14 health and human services has sufficient insurance-relevant 15 information to determine the taxpayer or a member of the 16 taxpayers household is not eligible for the Medicaid program 17 but may be eligible for other health care coverage programs 18 under the purview of the department, contact the taxpayer to 19 provide the taxpayer with information about the other health 20 care coverage program options including specific benefits 21 and cost-sharing requirements, enrollment instructions, and 22 enrollment assistance. 23 (3) Following the assessment, if the department of health 24 and human services does not have sufficient insurance-relevant 25 information to determine if the taxpayer or a member of the 26 taxpayers household is eligible for the Medicaid program 27 or other health care coverage programs under the purview of 28 the department, contact the taxpayer to obtain sufficient 29 information to make a determination. 30 c. Following the assessment, if the Iowa health insurance 31 marketplace determines the taxpayer or a member of the 32 taxpayers household may be eligible for a qualified health 33 plan or financial assistance through the Iowa health insurance 34 marketplace, the Iowa health insurance marketplace shall 35 -3- LSB 2186YH (2) 91 jm/jh 3/ 11
H.F. 355 contact the taxpayer and provide the taxpayer with information 1 on all of the following: 2 (1) Qualified health plans available to the taxpayer or 3 a member of the taxpayers household through the Iowa health 4 insurance marketplace. 5 (2) Specific enrollment instructions and information 6 on enrollment assistance for each of the qualified health 7 plans available to the taxpayer or a member of the taxpayers 8 household. 9 (3) Information on the federal premium assistance credit 10 provided pursuant to 26 U.S.C. 36B. 11 5. Notwithstanding any state confidentiality or privacy 12 protection or other provision of law to the contrary, the 13 department may share confidential tax return information with 14 the department of health and human services and the Iowa health 15 insurance marketplace to the extent the confidential tax return 16 information constitutes insurance-relevant information and the 17 department has received the taxpayers consent to share the 18 information. 19 6. The provision of information by a taxpayer under this 20 section is voluntary and a taxpayer shall not be subject to a 21 penalty for not providing the information specified under this 22 section. 23 7. The department, the department of health and human 24 services, and the insurance division shall collaboratively do 25 all of the following: 26 a. Develop the instructions for completion of the income 27 tax return form and compile other information to accompany the 28 income tax form provided to taxpayers under this section. 29 b. Define terms for the purposes of both completion of the 30 income tax form and for information about and eligibility for 31 health care coverage programs including the terms dependent 32 and household. 33 c. Develop outreach educational materials and programming 34 to communicate the availability and the purpose of the easy 35 -4- LSB 2186YH (2) 91 jm/jh 4/ 11
H.F. 355 enrollment health care coverage program to the public. The 1 materials and programming shall include materials developed for 2 different target groups, including but not limited to in-person 3 and online tax preparers, consumer assistance organizations, 4 community groups, and underserved groups. 5 d. Enter into any data-sharing agreements necessary to 6 facilitate insurance-relevant information sharing and tracking, 7 eligibility verification procedures, and outreach efforts. 8 e. Consider criteria for automatic exclusions such as 9 taxpayers who do not reside in the state. 10 f. Notify and provide training for both in-person tax 11 preparers and electronic tax preparation programs regarding the 12 changes to the tax forms to facilitate software updates and 13 compliance. 14 g. Automate the tracking and response mechanisms to the 15 greatest extent possible. 16 h. Develop and utilize any other processes or procedures 17 that facilitate the easy enrollment health care coverage 18 program. 19 8. Beginning January 15, 2027, and annually thereafter, 20 the department, the department of health and human services, 21 and the insurance division shall collaboratively report to 22 the governor and the general assembly all of the following 23 information based on the immediately preceding calendar years 24 tax return data: 25 a. The number of taxpayers who indicated on their tax form 26 that the taxpayer, the taxpayers spouse, a dependent of the 27 taxpayer, or another household member of the taxpayer did not 28 have health care coverage. 29 b. The number of taxpayers who authorized the sharing of 30 insurance-relevant information for the purposes of assessing 31 eligibility for a health care coverage program. 32 c. The number of taxpayers or members of a taxpayers 33 household provisionally assessed as eligible for a health care 34 coverage program. 35 -5- LSB 2186YH (2) 91 jm/jh 5/ 11
H.F. 355 d. The number of taxpayers or members of a taxpayers 1 household who enrolled in a health care coverage program as the 2 result of the easy enrollment health care coverage program, and 3 the type of health care coverage program in which the person 4 enrolled. 5 e. Demographic data on enrollment in specific health care 6 coverage programs resulting from the easy enrollment health 7 care coverage program. 8 f. Recommendations to improve outreach materials, address 9 issues related to information required for establishing 10 eligibility while maintaining confidentiality, and other 11 proposed changes to improve the easy enrollment health care 12 coverage program. 13 9. The department, the department of health and human 14 services, and the insurance division shall each adopt rules 15 pursuant to chapter 17A to jointly implement and administer 16 the easy enrollment health care coverage program under this 17 section. 18 10. As used in this section: 19 a. Affordable Care Act means the federal Patient 20 Protection and Affordable Care Act, Pub. L. No. 111-148, as 21 amended by the federal Health Care and Education Reconciliation 22 Act of 2010, Pub. L. No. 111-152, and any amendments thereto. 23 b. Health care coverage program means the Medicaid 24 program, the healthy and well kids in Iowa program, the Iowa 25 health and wellness plan, or a qualified health plan available 26 through the Iowa health insurance marketplace. 27 c. Healthy and well kids in Iowa program or Hawki program 28 means the Hawki program as defined in section 514I.2. 29 d. Household means the spouse, any dependent, and any 30 other individual who resides with the taxpayer but is not 31 claimed as a spouse or dependent on the taxpayers income tax 32 return. 33 e. Insurance division means the insurance division of the 34 department of insurance and financial services. 35 -6- LSB 2186YH (2) 91 jm/jh 6/ 11
H.F. 355 f. Insurance-relevant information means information 1 pertaining to the insurance enrollment status of a taxpayer 2 or members of a taxpayers household and that is derived or 3 obtained from the taxpayers state income tax return; provided 4 that information is limited to information necessary to assess 5 the eligibility of the taxpayer or members of the taxpayers 6 household for health coverage programs and includes: 7 (1) Adjusted gross income and other types of reported income 8 used to assess eligibility for a health coverage program. 9 (2) Household size. 10 (3) Claimed dependents. 11 (4) Contact information and personally identifying 12 information necessary to assess health coverage program 13 eligibility and used to match against relevant third-party data 14 sources. 15 (5) Any other information necessary to determine 16 eligibility for a health care coverage program as specified by 17 rule of the department, in consultation with the department of 18 health and human services and the insurance division. 19 g. Iowa health and wellness plan means the Iowa health and 20 wellness plan established in chapter 249N. 21 h. Iowa health insurance marketplace means the American 22 health benefits exchange created pursuant to the Affordable 23 Care Act. 24 i. Medicaid program means the same as defined in section 25 249A.2. 26 j. Qualified health plan means an insurance plan that is 27 certified by the Iowa health insurance marketplace, provides 28 essential health benefits, follows established limits on 29 cost-sharing including for deductibles, copayments, and 30 out-of-pocket maximum amounts, and meets other requirements 31 under the Affordable Care Act. 32 EXPLANATION 33 The inclusion of this explanation does not constitute agreement with 34 the explanations substance by the members of the general assembly. 35 -7- LSB 2186YH (2) 91 jm/jh 7/ 11
H.F. 355 This bill establishes an easy enrollment health care 1 coverage program. The bill requires the department of revenue 2 (DOR) in cooperation with the department of health and human 3 services (HHS) and the insurance division of the department 4 of insurance and financial services (insurance division) to 5 establish an easy enrollment health care coverage program 6 (program) utilizing the state income tax form to identify 7 residents of the state who are uninsured but may qualify for 8 benefits under a health care coverage program. The program is 9 designed to facilitate identification of taxpayers and members 10 of taxpayers households who are uninsured; provide taxpayers 11 with a method to authorize the sharing of insurance-relevant 12 information for the purpose of assessing eligibility for a 13 health care coverage program; provide for automatic enrollment 14 or provisionally assessed eligibility of the taxpayer or a 15 member of the taxpayers household in the Medicaid program or 16 other health care coverage program; and facilitate enrollment 17 in a health care coverage program. 18 For the tax year beginning January 1, 2025, the director of 19 revenue (director), or the directors designee shall develop 20 the income tax form to include specific options for a taxpayer 21 who files an individual or joint income tax return to indicate 22 certain information, including that the taxpayer either does 23 or does not have health care coverage, that the spouse of the 24 taxpayer either does or does not have health care coverage, 25 each of the dependents of the taxpayer who do not have health 26 care coverage and their birth dates, information about 27 other members of the taxpayers household including whether 28 the individual does or does not have health care coverage, 29 authorization for DOR to share insurance-relevant information 30 with the Iowa health insurance marketplace (marketplace) and 31 HHS; authorization for HHS to enroll the taxpayer or a member 32 of the taxpayers household in the Medicaid program if HHS 33 has sufficient insurance-relevant information to complete 34 an eligibility determination; and the taxpayers contact 35 -8- LSB 2186YH (2) 91 jm/jh 8/ 11
H.F. 355 information for their preferred method of communication. 1 The bill provides alternative processes that the marketplace 2 and HHS may follow depending on whether the taxpayer indicates 3 the taxpayer or anyone in the taxpayers household does not 4 have health care coverage, the taxpayer authorizes the sharing 5 of the taxpayers insurance-relevant information, and the 6 taxpayers insurance-relevant information and authorization are 7 shared with the marketplace and HHS. Once the marketplace and 8 HHS receive the taxpayers insurance-relevant information, the 9 marketplace and HHS shall assess the taxpayers eligibility 10 or the eligibility of the members of the taxpayers household 11 for a health care coverage program. Following the assessment, 12 if HHS has sufficient insurance-relevant information to 13 determine the taxpayer or a member of the taxpayers household 14 is eligible for the Medicaid program, and if the taxpayer 15 authorized such enrollment, HHS shall enroll the eligible 16 taxpayer or eligible member of the taxpayers household in 17 the Medicaid program. If the taxpayer did not authorize 18 such enrollment in the Medicaid program, HHS shall contact 19 the taxpayer and provide the taxpayer with information on 20 the Medicaid program. Following the assessment, if HHS 21 has sufficient insurance-relevant information to determine 22 the taxpayer or a member of the taxpayers household is not 23 eligible for the Medicaid program but may be eligible for 24 other health care coverage programs under the purview of 25 HHS, HHS shall contact the taxpayer to provide the taxpayer 26 with information about the other health care coverage 27 program options, including specific benefits and cost-sharing 28 requirements, enrollment instructions, and enrollment 29 assistance. Following the assessment, if HHS does not have 30 sufficient information to determine if the taxpayer or a member 31 of the taxpayers household is eligible for the Medicaid 32 program or another health care coverage program under the 33 purview of the department, contact the taxpayer to obtain 34 sufficient information to make a determination. 35 -9- LSB 2186YH (2) 91 jm/jh 9/ 11
H.F. 355 Following the assessment, if the marketplace determines 1 the taxpayer or a member of the taxpayers household may be 2 eligible for a qualified health plan or financial assistance 3 through the marketplace, the marketplace shall contact the 4 taxpayer and provide the taxpayer with specific information 5 about the qualified health plans available through the 6 marketplace. 7 The bill provides that notwithstanding any state 8 confidentiality or privacy protection or other provision 9 of law to the contrary, DOR may share confidential tax 10 return information with HHS and the marketplace to the 11 extent the confidential tax return information constitutes 12 insurance-relevant information and DOR has received the 13 taxpayers authorization to share the information. 14 The provision of information by a taxpayer under the bill is 15 voluntary and a taxpayer shall not be subject to a penalty for 16 not providing the information. 17 The bill requires DOR, HHS, and the insurance division to 18 collaboratively develop the tax return form and accompanying 19 information to be provided to taxpayers; develop outreach 20 educational materials and programming to communicate the 21 availability and the purpose of the program to the public; 22 enter into any data-sharing agreements necessary to facilitate 23 insurance-relevant information sharing and tracking, 24 eligibility verification procedures, and outreach efforts; 25 consider criteria for automatic exclusions such as taxpayers 26 who do not reside in the state; notify and provide training for 27 both in-person tax preparers and electronic tax preparation 28 programs regarding the changes to the tax forms to facilitate 29 software updates and compliance; automate the tracking and 30 response mechanisms to the greatest extent possible; and 31 develop and utilize any other processes or procedures that 32 facilitate the program. 33 Beginning January 15, 2027, and annually thereafter, DOR, 34 HHS, and the insurance division shall collaboratively report 35 -10- LSB 2186YH (2) 91 jm/jh 10/ 11
H.F. 355 specified information and recommendations to the governor 1 and the general assembly based on the immediately preceding 2 calendar years tax return data. 3 DOR, HHS, and the insurance division shall each adopt 4 administrative rules to jointly implement and administer the 5 program. 6 The bill provides definitions used in the bill. 7 -11- LSB 2186YH (2) 91 jm/jh 11/ 11