12.03 Applicable tax filer56

In general. Except as otherwise provided in this subsection, an applicable tax filer is a tax filer who expects to have household income of at least 100 percent but not more than 400 percent of the FPL for the tax filer’s family size for the benefit year. For purposes of calculating the household income of an applicable tax filer and determining their financial eligibility for APTC, see § 28.05. Married tax filers must file joint return Except as provided in (2) below, a tax filer who is married (within the meaning of 26 CFR § 1.7703-1) at the close of the benefit year is an applicable tax filer only if the tax filer and the tax filer's spouse file a joint return for the benefit year. Victims of domestic abuse and spousal abandonment: Except as provided in (5) below, a married tax filer will satisfy the joint filing requirement if the tax filer files a tax return using a filing status of married filing separately and: (i) Is living apart from their spouse at the time they file their tax return; (ii) Is unable to file a joint return because they are a victim of domestic abuse as defined in (3) below or spousal abandonment as defined in (4) below; and (iii) Certifies on their tax return, in accordance with the relevant instructions, that they meet the criteria under (i) and (ii) above. Domestic abuse. Domestic abuse includes physical, psychological, sexual, or emotional abuse, including efforts to control, isolate, humiliate and intimidate, or to undermine the victim’s ability to reason independently. All the facts and circumstances are considered in determining whether an individual is abused, including the effects of alcohol or drug abuse by the victim’s spouse. Depending on the facts and circumstances, abuse of the victim’s child or another family member living in the household may 55 See generally, 26 CFR § 1.36B-2 and 45 CFR § 155.305(f). 56 26 CFR § 1.36B-2(b); 45 CFR § 155.305. Eligibility Standards Part 2 – Page 27 (Sec.12.00, Sub.12.03) constitute abuse of the victim. Abandonment. The tax filer is a victim of spousal abandonment for the taxable year if, taking into account all facts and circumstances, the tax filer is unable to locate their spouse after reasonable diligence. Three-year rule. Paragraph (2) above does not apply if the tax filer met the requirements of the paragraph for each of the three preceding taxable years. Tax dependent. An individual is not an applicable tax filer if another tax filer may claim a deduction under 26 USC § 151 for the individual for a benefit year beginning in the calendar year in which the individual's benefit year begins. Individual not lawfully present or incarcerated. 57 An individual who is not lawfully present in the United States or is incarcerated (other than incarceration pending disposition of charges) is not eligible to enroll in a QHP through VHC. However, the individual may be an applicable tax filer for purposes of claiming the premium tax credit if a family member is eligible to enroll in a QHP. [Reserved] Special rule for tax filers with household income below 100 percent of the FPL for the benefit year. 58 A tax filer (other than a tax filer described in paragraph (e) of this subsection) whose household income for a benefit year is less than 100 percent of the FPL for the tax filer’s family size is treated as an applicable tax filer for purposes of claiming the premium tax credit if: The tax filer or a family member enrolls in a QHP through VHC for one or more months during the taxable year; AHS estimates at the time of enrollment that the tax filer’s household income will be at least 100 but not more than 400 percent of the FPL for the benefit year; APTCs are authorized and paid for one or more months during the benefit year; and The tax filer would be an applicable tax filer if the tax filer’s household income for the benefit year was at least 100 but not more than 400 percent of the FPL for the tax filer’s family size. Computation of premium-assistance amounts for tax filers with household income below 100 percent of the FPL. If a tax filer is treated as an applicable tax filer under paragraph (e) or (f) of this subsection, the tax filer’s actual household income for the benefit year is used to compute the premium-assistance amounts under § 60.00. 57 See, ACA §§ 1312(f)(1)(B) and 1312(f)(3) (42 USC § 18032(f)(1)(B) and (f)(3)) and 26 CFR § 1.36B-2(b)(4). 58 26 CFR § 1.36B-2(b)(6). Eligibility Standards Part 2 – Page 28 (Sec.13.00, Sub.0)