TITLE 25. Individual Market Assistance [100800. - 100825.]

Cal. Government Code - GOV 25.
in effect

Cal. Government Code - GOV § 100800. Section 100800.

(a) The Exchange shall administer a program of financial assistance to help low-income and middle-income Californians access affordable health care coverage through the Exchange. (b) The program may provide financial assistance to California residents with household incomes at or below 600 percent of the federal poverty level, and may provide other appropriate subsidies designed to make health care coverage more accessible and affordable for individuals and households. (c) Upon appropriation by the Legislature, the Exchange shall adopt, and may amend, an annual program design for each coverage year to implement this section by resolution of the board of the Exchange. The resolution shall be adopted at a duly noticed meeting. (1) A resolution adopted pursuant to this section shall not take effect until 10 days after notification in writing to the Joint Legislative Budget Committee. (2) The requirements of paragraph (1) may be waived by the written consent of the Chair of the Joint Legislative Budget Committee to adopt a resolution that is deemed urgent. A resolution adopted pursuant to this paragraph shall take immediate effect. (3) The Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code) shall not apply to the program design or a resolution adopted pursuant to this section. (d) The program design adopted for a coverage year shall be based on funds appropriated to the program for that coverage year. An appropriation made for the program shall contain provisional language directing the Exchange to provide a certain proportion of the funds to specified income ranges as determined by the Legislature and may provide other parameters guiding the design of the program. (1) Pursuant to the Budget Act of 2023, the program shall be funded at an amount up to eighty-two million five hundred thousand dollars ($82,500,000) for coverage year 2024. (2) It is the intent of the Legislature, beginning in the 2024–25 fiscal year, to appropriate up to one hundred sixty-five million dollars ($165,000,000) in the annual Budget Act to the program for each coverage year of the program after coverage year 2024. (e) The Exchange shall provide appropriate opportunities for stakeholders and the public to consult in the design of the program.

Cal. Government Code - GOV § 100805. Section 100805.

(a) A premium assistance subsidy provided by the program shall be able to be advanced to program participants and shall be remitted by the Exchange to a qualified health plan issuer, based on the program participant’s projected household income, family size, and other factors determined pursuant to the program design and subject to reconciliation against actual household income, family size, and other factors determined pursuant to the program design as provided in Section 100810. (b) A premium assistance subsidy provided by the program shall be provided only to a California resident who is eligible for the federal premium tax credit authorized under Section 36B of the Internal Revenue Code, except that premium assistance subsidy shall not be subject to the income requirements of that section. (c) Gross income, as defined in Section 17071 of the Revenue and Taxation Code, does not include an amount received as a premium assistance subsidy provided by the program.

Cal. Government Code - GOV § 100810. Section 100810.

(a) A responsible individual shall reconcile premium assistance subsidies advanced pursuant to subdivision (a) of Section 100805 to the responsible individual or the responsible individual’s dependents with the premium assistance subsidies allowed based on actual household income, family size, and other factors determined pursuant to the program design for a coverage year during which the responsible individual or the responsible individual’s dependents received an advanced premium assistance subsidy, as follows: (1) If a program participant’s allowed premium assistance subsidies for the taxable year exceed the program participant’s advanced premium assistance subsidies, the program participant may receive the excess as a premium assistance subsidy reconciliation refund. The Franchise Tax Board shall remit the refund to the program participant, less any taxes, fees, and penalties the program participant owes to the state. If a program participant is a dependent, the Franchise Tax Board shall remit the refund to the responsible individual, less any taxes, fees, and penalties the responsible individual or program participant owes to the state. (2) If a program participant’s advanced premium assistance subsidies for the taxable year exceed the program participant’s allowed premium assistance subsidies, the program participant shall have a liability in the amount equal to the excess of the advanced premium assistance subsidies over the program participant’s allowed premium assistance subsidies as a reconciliation liability, up to a limit specified by the program design. The program design may vary that limit based on household income. (3) The responsible individual shall reconcile premium assistance subsidies in accordance with this section, and shall include the liability imposed by this section or the premium assistance subsidy reconciliation refund on a return filed pursuant to Chapter 2 (commencing with Section 18501) of Part 10.2 of the Revenue and Taxation Code for the taxable year. (4) If a program participant with a liability imposed by this section is a dependent, the responsible individual shall be solely liable for that liability of the dependent. (5) If a responsible individual with a liability imposed by this section files a joint return for the taxable year, the responsible individual and the spouse or domestic partner of the responsible individual shall be jointly and severally liable for that liability. (6) Notwithstanding the return filing thresholds requirements in Chapter 2 (commencing with Section 18501) of Part 10.2 of the Revenue and Taxation Code, a responsible individual shall file a California income tax return with the Franchise Tax Board for the purpose of reconciliation as required under this section. (b) The Franchise Tax Board’s civil authority and procedures for purposes of compliance with notice and other due process requirements imposed by law to collect income taxes shall be applicable to the collection of the premium assistance subsidy reconciliation liability due pursuant to subdivision (a). The amount due shall be paid upon notice and demand by the Franchise Tax Board and shall be assessed and collected pursuant to Part 10.2 (commencing with Section 18401) of the Revenue and Taxation Code. (c) The Franchise Tax Board shall integrate enforcement of the liability imposed pursuant to subdivision (a) into existing activities, protocols, and procedures, including audits, enforcement actions, and taxpayer education efforts.

Cal. Government Code - GOV § 100815. Section 100815.

For purposes of this title: (a) “Coverage year” means a calendar year in which a program participant, or the program participant’s spouse, domestic partner, or dependent, received financial assistance pursuant to this title. (b) “Dependent” means a dependent, as defined in Section 17056 of the Revenue and Taxation Code (c) “Exchange” means the California Health Benefit Exchange, also known as Covered California, established pursuant to Title 22 (commencing with Section 100500). (d) “Family size” shall be defined in the program design adopted pursuant to Section 100800. (e) “Federal poverty level” shall be defined in the program design adopted pursuant to Section 100800. (f) “Household income” shall be defined in the program design adopted pursuant to Section 100800. (g) “Modified adjusted gross income” shall be defined in the program design adopted pursuant to Section 100800. (h) “Program” means Individual Market Assistance established pursuant to Section 100800. (i) “Program participant” means an individual eligible to receive financial assistance pursuant to this title. (j) “Qualified health plan” has the same meaning as defined in Section 1301 of the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152). (k) “Responsible individual” means a program participant or an individual with a dependent who is a program participant. With respect to a dependent, “responsible individual” means the individual who claims the dependent as a dependent. (l) With respect to a program participant’s household income or size: (1) “Actual” means the household income or family size determined to have applied for the coverage year in accordance with the program design adopted pursuant to Section 100800. (2) “Projected” means the household income or family size projected for the coverage year in accordance with the program design adopted pursuant to Section 100800.

Cal. Government Code - GOV § 100820. Section 100820.

(a) The Exchange may, in consultation with the Franchise Tax Board, promulgate rules and regulations as necessary to implement this title that are consistent with the program design adopted pursuant to Section 100800. (b) The Franchise Tax Board may, in consultation with the Exchange, adopt regulations that are necessary and appropriate to implement Section 100810 and that are consistent with the program design adopted pursuant to Section 100800 and regulations adopted by the Exchange pursuant to this section. (c) The Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code) shall not apply to a regulation, standard, criterion, procedure, determination, rule, notice, guideline, or any other guidance established or issued by the Exchange or Franchise Tax Board pursuant to this title. (d) In construing this title, the regulations promulgated by the Exchange under Title 10 of the California Code of Regulations shall apply to the extent that those regulations do not conflict with this title, the program design adopted pursuant to Section 100800, regulations promulgated by the Exchange pursuant to this section, and regulations promulgated by the Franchise Tax Board pursuant to this section. (e) It is the intent of the Legislature that, in construing this title, the regulations promulgated under Section 36B of the Internal Revenue Code shall apply to the extent that those regulations do not conflict with this title or regulations promulgated by the Exchange pursuant to subdivision (a) or Franchise Tax Board pursuant to subdivision (b).

Cal. Government Code - GOV § 100825. Section 100825.

This title shall not be construed to create an entitlement program of any kind, to appropriate any funds, to require the Legislature to appropriate any funds, or to increase or decrease taxes owed by a taxpayer.
Source: CA Legislative Counsel Bulk DataURL: https://downloads.leginfo.legislature.ca.gov/pubinfo_2025.zipFetched: 6/27/2026