Health insurance aid would follow income and enrollment rules

Tax officials would use the listed income scale to calculate premium tax credits and treat covered Medicaid-gap taxpayers as having income at 100% of poverty with a 0% rate. The Medicaid-gap rule covers people below poverty who would otherwise have minimum essential coverage but for their state's choice not to cover the specified Medicaid adult group. Catastrophic health plans would not qualify. The joint-return requirement would still apply. Two numbered premium-credit provisions added by Public Law 119–21 would be removed, but their contents are not provided. The general credit rules would apply to tax and plan years beginning after December 31, 2025; the Medicaid-gap rule would apply to tax years beginning after December 31, 2026.

The Medicaid matching formula would use a 24-quarter period and an increase figure of 10 for qualifying state plans. The provision covers states that did not spend Medicaid funds for everyone in the specified adult eligibility group before January 1, 2026. The 24-quarter period and figure of 10 would apply to qualifying matching periods beginning on or after January 1, 2026.

Affected laws and regulations would be applied as though four named sections of Public Law 119–21 and their amendments had not been enacted. The repeal covers sections 71107, 71112, 71119, and 71120 of Public Law 119–21. The bill does not reproduce those sections, so their effects on particular people, benefits, or duties are not explained.

Federal officials would verify broker-assisted activity, set participation rules for agents and marketing organizations, and give consumers account access and notices about changes. Verification covers commission-eligible submissions to federally operated Marketplaces. Broader participation standards would guide states and cover the path from marketing through enrollment. Agents must put enrollees' interests first and provide proof of consent. Marketing groups must meet licensing, registration, marketing, and reporting rules. Commissions would wait until enrollment problems are resolved. Marketing groups and insurers would report covered terminations, and consumers could not be disenrolled without consent. The Secretary would choose the start date for verification and participation standards, but it could be no later than January 1, 2029.

Federal officials would audit agents and brokers, share suspected fraud with states, list suspended or terminated brokers, check death records, disclose tax-credit amounts, and enforce penalties. The information penalties cover agents and brokers handling Marketplace plan applications. Agreement termination applies only to agents and brokers working with federally operated Marketplaces. Negligent errors could cost $10,000 to $50,000 per affected person. Knowing fraud could cost up to $200,000 per person, up to 10 years in prison, or both. Officials must verify a death before ending coverage. A federally operated Marketplace may end an agreement for cause when the evidence shows a violation is more likely than not. Annual sign-ups would run November 1 through the following January 15 beginning with 2026. Penalties apply to applications for plan years on or after January 1, 2027. Tax-credit notices begin January 1, 2027. Death checks begin within 90 days after enactment and repeat quarterly. Audits must begin by January 1, 2029.