Requiring verification of eligibility for premium tax credit

(a) In general Section 36B(c) is amended by adding at the end the following new paragraphs: (5) Exchange enrollment verification requirement (A) In general 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— (i) to enroll in the plan through the Exchange, (ii) for any advance payment under section 1412 of the Patient Protection and Affordable Care Act of the credit allowed under this section, and (iii) for any reduced cost-sharing under section 1402 of such Act. (B) Applicable enrollment information 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)): (i) Income. (ii) Any immigration status. (iii) Any health coverage status or eligibility for coverage. (iv) Place of residence. (v) Family size. (vi) 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). (C) Verification of past months 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. (D) Exchange participation; coordination with other procedures for determining eligibility 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. (6) Exchange compliance with filing requirements 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.. (b) Pre-enrollment verification process required Section 36B(c)(3)(A) is amended— (1) by striking health plan.— The term and inserting the following: health plan.— (i) In general The term, and (2) by adding at the end the following new clause: (ii) Pre-enrollment verification process required 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.. (c) Regulations 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. (d) Effective date The amendments made by this section shall apply to taxable years beginning after December 31, 2027.

(a) In general Section 36B(c) is amended by adding at the end the following new paragraphs: (5) Exchange enrollment verification requirement (A) In general 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— (i) to enroll in the plan through the Exchange, and (ii) for any advance payment under section 1412 of the Patient Protection and Affordable Care Act of the credit allowed under this section. (B) Applicable enrollment information For purposes of subparagraph (A), applicable enrollment information shall include affirmation of at least the following information (to the extent relevant in determining eligibility described in subparagraph (A)): (i) Household income and family size. (ii) Whether the individual is an eligible alien. (iii) Any health coverage status or eligibility for coverage. (iv) Place of residence. (v) 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). (C) Verification of past months In the case of a month that begins before verification prescribed by subparagraph (A), such month shall be treated as a coverage month 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 and for any such advance payment. (D) Exchange participation; coordination with other procedures for determining eligibility 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. (E) Waiver for certain special enrollment periods The Secretary may waive the application of subparagraph (A) in the case of an individual who enrolls in a qualified health plan through an Exchange for 1 or more months of the taxable year during a special enrollment period provided by the Exchange on the basis of a change in the family size of the individual. (F) Information and reliance on third-party sources An Exchange shall be permitted to use any data available to the Exchange and any reliable third-party sources in collecting information for verification by the applicant. (6) Exchange compliance with filing requirements 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)(iii) of title 45, Code of Federal Regulations (as published in the Federal Register on June 25, 2025 (90 Fed. Reg. 27074), applied as though it applied to all plan years after 2025), with respect to the individual.. (b) Pre-enrollment verification process required Section 36B(c)(3)(A) is amended— (1) by striking health plan.—The term and inserting “ health plan.— (i) In general The term, and (2) by adding at the end the following new clause: (ii) Pre-enrollment verification process required 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 household income and eligibility for enrollment in such plan for plan years beginning in the subsequent year.. (c) Effective date The amendments made by this section shall apply to taxable years beginning after December 31, 2027.