10. How does tax filing affect eligibility for ConnectorCare?

ConnectorCare is subsidized through a premium tax credit that may be paid in advance to the HMO to lower the member’s premium costs during the year. In order to qualify for a premium tax credit and ConnectorCare the following criteria related to federal tax filing must be satisfied:

  • An individual must file a federal tax return for the year in which the taxpayer is seeking a premium tax credit for the taxpayer, spouse or other individuals claimed as tax dependents, and an applicant for ConnectorCare must attest that he or she will file a federal tax return for the tax year in which the premium tax credit is paid in advance. 
  • An individual, who will be “married” within the meaning of 26 USC 7703 as of Dec 31, is not eligible for a premium tax credit if he or she plans to file a return as married filing separately unless the taxpayer is unable to file jointly due to abuse or abandonment of the other spouse.
    • Head of household. A person who is married but living apart from a spouse during at least the last 6 months of the year, and who supplies over half the costs of maintaining a household that is the principal home for a child for more than half the year and can claim the child as a tax dependent may file as a “head of household” and is not considered “married” under 26 USC 7703
    • Domestic abuse is broadly defined as physical or emotional including efforts to control or intimidate and may include abuse of the victim’s child or other family member. 26 CFR 1.36B2(a)(2)(iii).
    • Abandonment in a taxable year is defined as being unable to locate a spouse after reasonable diligence. 26 CFR 1.36B2(a)(2)(iv).
  • An individual who received an advanced premium tax credit in any year and failed to file a federal return and the required form to reconcile the amount of the credit received in advance with the amount due, as described in Q & A 30, will not be eligible for an advance premium tax credit or ConnectorCare until filing the required tax forms for the prior period. However, a current enrollee will be notified in advance and given an opportunity to file the required tax forms before having their ConnectorCare terminated. 45 CFR 155.305(f)(4).