Relating to the establishment of an easy enrollment health care coverage program utilizing the state income tax form

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, 2025, 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, 2027, 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.