Section 4500.190  Eligibility and Special Rules on Advanced Payments of the Premium Tax Credit and Cost-Sharing Reductions

a)         A tax filer is eligible for APTCs if the tax filer meets the criteria in 45 CFR 155.305(f).

b)         A tax filer is eligible for CSRs if the tax filer meets the criteria in 45 CFR 155.305(g).

c)         An applicant has the right to appeal an eligibility determination regarding APTCs and CSRs, including the amount calculated, as provided in 45 CFR Part 155, Subpart F.

d)         For plan years when Illinois operates a State-based Exchange on the Federal Platform, the Illinois Exchange will rely on HHS to determine eligibility for, calculate, and provide APTCs and CSRs and to conduct all related appeals.

e)         For plan years when Illinois operates a State-based Exchange, the Illinois Exchange will determine eligibility for, calculate, and provide information on APTCs and CSRs under this Section, and the Illinois Exchange will conduct related appeals under Section 4500.230. HHS will continue to make actual payments of the APTCs and, if applicable, CSRs.

(Source:  Amended at 49 Ill. Reg. 14672, effective October 28, 2025)