Bill Text: IA HSB741 | 2023-2024 | 90th General Assembly | Introduced

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Bill Title: A bill for an act relating to the establishment of an easy enrollment health care coverage program utilizing the state income tax form.

Spectrum: Committee Bill

Status: (Introduced) 2024-03-26 - Subcommittee recommends passage. Vote Total: 3-0. [HSB741 Detail]

Download: Iowa-2023-HSB741-Introduced.html

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House Study Bill 741 - Introduced
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:
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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.
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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
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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
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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
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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.
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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.
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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.
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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
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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.
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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
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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.
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