It’s April, which means it’s tax time. An increasing number of people aren’t just thinking about their tax refunds, they’re thinking about health insurance. That’s because Maryland, Colorado, Massachusetts, Pennsylvania, Virginia, New Mexico, New Jersey, Maine, California, and Illinois have established Easy Enrollment programs which open a pathway to health insurance enrollment for the uninsured when they file their state income taxes.  

The program works by allowing individuals to check a box on their state tax return, giving the state department of revenue permission to share pertinent details with the state Medicaid office and health insurance exchange/marketplace. Based on this information, a preliminary determination is made about the tax filer’s eligibility for financial assistance with their health coverage, either through Medicaid/CHIP or a premium tax credit (subsidy) in the exchange. 

Once the state Medicaid office or health insurance exchange determines the tax filer’s eligibility, they will reach out to them to provide notification and enrollment assistance through a special enrollment period. This may include providing information on the different health care plans available, their costs, and their coverage options.  

A study by the Commonwealth Fund found that the Easy Enrollment programs in California and Maryland resulted in a significant increase in enrollment in the states’ health insurance exchanges in the first year alone. Easy Enrollment programs were launched in both states during the 2020 tax season. In Maryland this resulted in an additional 4,000 enrollees in the state’s health insurance marketplace, which represented a 3.5% increase in enrollment compared to the previous year. In California, the program resulted in an additional 38,000 enrollees, which represented a 9% increase in enrollment compared to the previous year.  

Easy Enrollment programs can be particularly effective for reaching populations that may face barriers to enrolling in health insurance, such as low-income individuals, those with limited English proficiency, or even those who just aren’t aware of cost-saving subsidies available to them. By integrating enrollment into the tax filing process, these programs can jump start the enrollment process and make it more accessible. 

Setting up an easy enrollment program 

With the historically low uninsured rate in jeopardy as the public health emergency unwinds (PHE), states may be looking for new ways to maintain and/or increase enrollment. Easy enrollment programs are one way to expand access to uninsured consumers. And, while not required, many states have taken a first step of setting up a state-based health insurance exchange 

Once the exchange is established, it will need to work closely with the state Medicaid and Department of Taxation offices to ensure that the necessary enrollment and notification procedures are in place. Based on existing programs, there are some best practices that can be followed, including: 

  • Require just enough data to enable the state-based exchange to provide an initial program eligibility assessment for Medicaid or a Qualified Health Plan, as well as an estimated savings amount for individuals who are eligible for Advanced Premium Tx Credit (APTC)/Cost Saving Reductions (CSR). 
  • Send follow-up notices to eligible individuals summarizing their eligibility and potential savings. These notices should include clear next steps to make the enrollment process as easy to understand and undertake as possible. 
  • Enable consumers to easily select coverage and enroll by streamlining the application and enrollment process for those who qualify for a tax-return special enrollment period (SEP). 

Awareness of the program is also crucial. The enrollment data available to the state with a state-based exchange can be leveraged to market to the state’s uninsured and underserved populations. Launching public awareness campaigns, partnering with community organizations, and working with tax preparers are all vital components of an integrated marketing campaign to ensure that the easy enrollment program reaches as many eligible individuals as possible.