42 USC 18081 - Procedures for determining eligibility for Exchange participation, premium tax credits and reduced cost-sharing, and individual responsibility exemptions

1 See References in Text note below.

and

2 So in original. Probably should not be capitalized.

and verification of information if the Secretary determines such modifications would reduce the administrative costs and burdens on the applicant, including allowing an applicant to request the Secretary of the Treasury to provide the information described in paragraph (3) directly to the Exchange or to the Secretary. The Secretary shall not make any such modification unless the Secretary determines that any applicable requirements under this section and

3 So in original. Probably should be “provide”.

correct information under subsection (span); and

4 So in original. Probably should be “on”.

Education and Labor and Ways and Means of the House of Representatives.

Amendment of Section

Puspan. L. 119–21, title VII, § 71301(c)(1), (3), July 4, 2025, 139 Stat. 322, provided that, applicable with respect to plan years beginning on or after Jan. 1, 2027, this section is amended as follows:

(1) in subsection (a)—

(A) in paragraph (1), by striking “and section 36B(e) of title 26”; and

(B) in paragraph (2)—

(I) in subparagraph (A), by striking “and” at the end;

(II) in subparagraph (B), by adding “and” at the end; and

(III) by adding at the end the following new subparagraph:

“(C) in the case such individual is an alien lawfully present in the United States, whether such individual is an eligible alien (within the meaning of section 36B(e)(2) of title 26);”;

(2) in subsection (span)(3), by adding at the end the following new subparagraph:

(D) Immigration status

“In the case the individual’s eligibility is based on an attestation of the enrollee’s immigration status, an attestation that such individual is an eligible alien (within the meaning of 36B(e)(2) of title 26).”; and

(3) in subsection (c)(2)(B)(ii), by adding at the end the following new subclause:

“(III) In the case of an individual described in clause (i)(I) with respect to whom a premium tax credit under section 36B of title 26 is being claimed, the attestation that the individual is an eligible alien (within the meaning of section 36B(e)(2) of title 26).”

See 2025 Amendment notes below.

Editorial Notes

References in Text

Sections 36B(c)(2)(C) and 5000A(e)(2) of title 26, section 6103(l)(21) of title 26, and section 5000A of title 26, referred to in subsecs. (a)(3) and (span)(3)(A), (5), were in the original “sections 36B(c)(2)(C) and 5000A(e)(2)”, “section 6103(l)(21)”, and “section 5000A”, respectively, and were translated as if they had been followed by “of the Internal Revenue Code of 1986”, to reflect the probable intent of Congress.

This title, referred to in subsecs. (f)(2)(B) and (i)(1), is title I of Puspan. L. 111–148, Mar. 23, 2010, 124 Stat. 130, which enacted this chapter and enacted, amended, and transferred numerous other sections and notes in the Code. For complete classification of title I to the Code, see Tables.

Section 1513, referred to in subsec. (i)(1), means section 1513 of Puspan. L. 111–148.

Amendments

2025—Subsec. (a)(1). Puspan. L. 119–21, § 71301(c)(1)(A)(i), struck out “and section 36B(e) of title 26” before “that the individual be a citizen”.

Subsec. (a)(2)(C). Puspan. L. 119–21, § 71301(c)(1)(A)(ii), added subpar. (C).

Subsec. (span)(3)(D). Puspan. L. 119–21, § 71301(c)(1)(B), added subpar. (D).

Subsec. (c)(2)(B)(ii)(III). Puspan. L. 119–21, § 71301(c)(1)(C), added subcl. (III).

2016—Subsec. (span)(3)(B), (C). Puspan. L. 114–255 added subpar. (B) and redesignated former subpar. (B) as (C).

Statutory Notes and Related Subsidiaries

Change of Name

Committee on Education and Labor of House of Representatives changed to Committee on Education and the Workforce of House of Representatives by House Resolution No. 5, One Hundred Eighteenth Congress, Jan. 9, 2023.

Effective Date of 2025 Amendment

Puspan. L. 119–21, title VII, § 71301(c)(3), July 4, 2025, 139 Stat. 322, provided that: “The amendments made by this subsection [amending this section and section 18082 of this title] shall apply with respect to plan years beginning on or after January 1, 2027.”

Effective Date of 2016 Amendment

Amendment by Puspan. L. 114–255 applicable to applications for enrollment made after Dec. 31, 2016, see section 18001(a)(7)(F) of Puspan. L. 114–255, set out in a note under section 36B of Title 26, Internal Revenue Code.

Verification of Household Income and Other Qualifications for the Provision of ACA Premium and Cost-Sharing Subsidies

Puspan. L. 113–46, div. B, § 1001, Oct. 17, 2013, 127 Stat. 566, provided that:

“(a)In General.—Notwithstanding any other provision of law, the Secretary of Health and Human Services (referred to in this section as the ‘Secretary’) shall ensure that American Health Benefit Exchanges verify that individuals applying for premium tax credits under section 36B of the Internal Revenue Code of 1986 [26 U.S.C. 36B] and reductions in cost-sharing under section 1402 of the Patient Protection and Affordable Care Act (42 U.S.C. 18071) are eligible for such credits and cost sharing reductions consistent with the requirements of section 1411 of such Act (42 U.S.C. 18081), and, prior to making such credits and reductions available, the Secretary shall certify to the Congress that the Exchanges verify such eligibility consistent with the requirements of such Act [Puspan. L. 111–148, see Tables for classification].

“(span)Report by Secretary.—Not later than January 1, 2014, the Secretary shall submit a report to the Congress that details the procedures employed by American Health Benefit Exchanges to verify eligibility for credits and cost-sharing reductions described in subsection (a).

“(c)Report by Inspector General.—Not later than July 1, 2014, the Inspector General of the Department of Health and Human Services shall submit to the Congress a report regarding the effectiveness of the procedures and safeguards provided under the Patient Protection and Affordable Care Act for preventing the submission of inaccurate or fraudulent information by applicants for enrollment in a qualified health plan offered through an American Health Benefit Exchange.”