Sec. 112201. Requiring Exchange verification of eligibility for health plan
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Section 36B(c) is amended by adding at the end the following new paragraphs: The term coverage month shall not include, with respect to any individual covered by a qualified health plan enrolled in through an Exchange, any month beginning before the Exchange verifies, using applicable enrollment information that shall be provided or verified by the applicant, such individual’s eligibility— to enroll in the plan through the Exchange, for any advance payment under section 1412 of the Patient Protection and Affordable Care Act of the credit allowed under this section, and for any reduced cost-sharing under section 1402 of such Act.
For purposes of subparagraph (A), applicable enrollment information shall at least include affirmation of the following information (to the extent relevant in determining eligibility described in subparagraph (A)): Income. Any immigration status. Any health coverage status or eligibility for coverage. Place of residence. Family size. Such other information as may be determined by the Secretary (in consultation with the Secretary of Health and Human Services) as necessary to the verification prescribed under subparagraph (A).
In the case of a month that begins before verification prescribed by subparagraph (A), such month shall be treated as a coverage month if, and only if, the Exchange verifies for such month (using applicable enrollment information that shall be provided or verified by the applicant) such individual’s eligibility to have so enrolled, for any such advance payment, and for any such reduced cost-sharing. An individual shall not, solely by reason of failing to meet the requirements of this paragraph with respect to a month, be treated for such month as ineligible to enroll in a qualified health plan through an Exchange.
The term coverage month shall not include, with respect to any individual covered by a qualified health plan enrolled in through an Exchange, any month for which the Exchange does not meet the requirements of section 155.305(f)(4) of title 45, Code of Federal Regulations (as published in the Federal Register on March 19, 2025 (90 FR 12942)), with respect to the individual. . Section 36B(c)(3)(A) is amended— by striking and inserting the following: health plan.— The term health plan.— The term , and by adding at the end the following new clause:
Such term shall not include any plan enrolled in through an Exchange, unless such Exchange provides a process for pre-enrollment verification through which any applicant may, beginning not later than August 1, verify with the Exchange the applicant’s eligibility for enrollment in such plan for plan years beginning in the subsequent year, for any advance payment of the credit allowed under this section, and for reduced cost-sharing under section 1402 of the Patient Protection and Affordable Care Act. .
The Secretary of the Treasury and the Secretary of Health and Human Services may each prescribe such rules and other guidance as may be necessary or appropriate to carry out the amendments made by this section. The amendments made by this section shall apply to taxable years beginning after December 31, 2027.