easy enrollment program

What is an easy enrollment program?

An easy enrollment program is a system that allows people without health insurance 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. That information is then used to make a preliminary determination about whether the tax filer and their family members might be eligible for financial assistance with their health coverage - either Medicaid/CHIP or a premium tax credit (subsidy) in the exchange.

The state Medicaid office or health insurance exchange will then reach out to the tax filer, notify them of the coverage and financial assistance for which they may qualify, and provide enrollment assistance.

Medicaid/CHIP enrollment is available year-round, but enrollment in a private plan through the health insurance exchange is only available during open enrollment or during a special enrollment period. Since open enrollment ends before the tax filing season gets underway, some states have established easy enrollment programs allowing people to be connected with health insurance via their tax return. In order to offer a Marketplace special enrollment period for people who aren't eligible for Medicaid/CHIP, the state must also run its own health insurance exchange (without this special enrollment opportunity, the person would have to wait until the next annual open enrollment period to sign up for coverage).

Which states have established easy enrollment programs?

The following states have enacted legislation to create easy enrollment programs:

• Maryland
• Colorado
• Massachusetts
• Pennsylvania
• Virginia (this was initially just for Medicaid/CHIP eligibility. Now that Virginia has a fully state-run exchange, the state tax return asks whether the filer would like their information to be provided to Virginia Medicaid and the Virginia Health Benefit Exchange.)¹
• New Mexico
• New Jersey
• Maine
• California
• Minnesota (available as of early 2025, for the 2024 tax year)²
• Illinois (Became available as of early 2023, for Medicaid. Illinois began running its own Marketplace enrollment platform, Get Covered Illinois, in the fall of 2025, and the state enacted legislation in 2025 to create a special enrollment period for people using the easy enrollment opportunity.)³

A state can only offer a special enrollment period for marketplace coverage if it runs its own health insurance exchange. In states that use HealthCare.gov, the federal government establishes parameters for special enrollment periods. Legislation (S.423 and H.R.1113) was introduced in Congress in 2023 to create a federal easy enrollment program as of 2026, but the bills did not advance.

All of the states that have created easy enrollment programs now have fully state-run Marketplaces. So their easy enrollment programs can check for eligibility for Medicaid/CHIP as well as premium subsidies, and can offer a special enrollment period in the marketplace if the person is not eligible for Medicaid/CHIP.

Will more states create easy enrollment programs?

Some additional states that run their own exchanges will likely consider establishing easy enrollment programs. Several other state-run exchanges could establish easy enrollment programs if state lawmakers support the idea. And federal lawmakers could choose to create a nationwide easy enrollment program, although legislation to this effect has not yet been successful.

Iowa lawmakers have introduced legislation in 2024 and 2025 to create an easy enrollment program, but the bills have not advanced.⁴

Delaware also considered easy enrollment legislation in 2023 and 2024, but it was not successful.⁵

Iowa and Delaware both use HealthCare.gov as their Marketplaces, so an easy enrollment program in either of those states would allow the state to enroll people in Medicaid or CHIP through the easy enrollment pathway, but would not allow a special enrollment period for qualified health plans in the Marketplace.

It's worth pointing out that the fiscal note for Maine's easy enrollment legislation noted that the state would incur a one-time $55,000 cost to reprogram state tax returns, and then a $4,000 ongoing annual cost for administration⁶ — so easy enrollment programs are inexpensive to establish.

The bulk of the cost would likely be additional Medicaid/CHIP enrollments stemming from the program, which is something that state lawmakers likely have in mind when considering these programs (premium subsidies in the Marketplace are funded by the federal government, although some states offer additional state-funded subsidies. Medicaid is jointly funded by the state and federal governments).

Can a state that uses HealthCare.gov create an easy enrollment program?

Yes, but with some limitations. A state can only create a special enrollment period for marketplace coverage if it runs its own marketplace. As of the 2026 plan year, 30 states rely on the federally-run exchange (HealthCare.gov) and thus cannot create their own special enrollment periods. DC and the other 20 states have the flexibility to implement their own special enrollment periods.

All of the states that have thus far created easy enrollment programs also run their own exchanges. But as described above, Virginia and Illinois both had their easy enrollment programs set up to connect tax filers with Medicaid until the state began running its own exchange and could offer a special enrollment period for Marketplace coverage.

How does an easy enrollment program benefit consumers?

Easy enrollment programs can reach consumers who might be unaware that they or a family member might be eligible for Medicaid, CHIP, or marketplace premium subsidies. Anyone who files a state tax return can use an easy enrollment program, and the state then does the work of making a preliminary determination of the person's eligibility for financial assistance with health coverage.

Since Medicaid/CHIP enrollment is available year-round, and since state-run exchanges have the flexibility to offer special enrollment periods to people who use the easy enrollment program, uninsured residents may find they can obtain low-cost or free health coverage soon after filing their tax returns.

Is easy enrollment the same as automatic enrollment?

Depending on how a state creates its easy enrollment program, it can also be a form of opt-in automatic enrollment. Public health experts generally support the idea of automatically enrolling uninsured people in health benefit programs if they're eligible for zero-cost coverage. And a tax return is a good way of obtaining some of the information necessary to do that.

If a state simply utilizes a check box on the state tax return, some additional information will generally be necessary to complete a health coverage enrollment, including immigration status and details about access to employer-sponsored health coverage. But a state could give tax filers the ability to provide this information along with their tax return, or to opt into a system that automatically enrolls the person if the necessary information is subsequently provided.

For tax filers who qualify for Marketplace coverage, a state can use information from its easy enrollment program to create a Marketplace account for the tax filer. The Marketplace can then reach out to the person and assist with the completion of the application and plan selection.

People who are eligible for subsidized - but not free - health coverage in the Marketplace can potentially be auto-enrolled, but they will need to pay a premium to activate their coverage. If the premium isn't paid, the coverage will not take effect.

Could the federal government create an easy enrollment program?

Yes, the federal government could create an easy enrollment program. In the fall of 2021, Senator Chris Van Hollen (D, Maryland) and Representative Ami Bera (D, California) introduced legislation (S.3001 and H.R.5610) to create a federal easy enrollment program.

Those bills did not advance, and the two lawmakers introduced similar legislation (S.423 and H.R.1113) in the 2023 session, but those did not advance either. They reintroduced the legislation in 2025,⁷ but the legislation still did not advance.⁸

Under the legislation introduced by Van Hollen and Bera, the federal easy enrollment program would be similar to the existing state-run programs. But it would use the federal tax return, and would allow for a special enrollment period in any state, including those that use the federally-run Marketplace. For uninsured residents who are eligible for zero-premium plans in the Marketplace (after subsidies are applied), the federal legislation also calls for the creation of a program that could automatically enroll them unless they opt-out or pick a different plan.