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Vermont Supreme Court Holds That a Woman’s Eligibility for ACA Subsidies Is Not Contingent on Her Spouse’s Decisions Regarding Health Insurance

In In re J.H., 2016 VT 122 (Dec. 2, 2016), the Supreme Court affirmed the Human Services Board’s determination that a low-income woman was eligible for health insurance subsidies despite her spouse’s (unused) eligibility for insurance through his employer.

Issue: Because of her household income ($34,000), J.H., a recently married young woman, was eligible for health insurance subsidies from Vermont Health Connect, but only if a Vermont Health Connect plan was the only way she was eligible for minimum coverage. J.H.’s husband was eligible for a health insurance plan through his employer, and if he enrolled in the plan, she would be eligible to enroll, too—which would, then, render her ineligible for subsidies by Vermont Health Connect. Her husband, however, was an unadopted former foster child over the age of 18, and thus was eligible for Medicaid until the age of 26. He elected to use Medicaid for his health care, as it was free.

Holding: The Supreme Court held that J.H. was not considered eligible for enrollment in her spouse’s employer-based health care plan, when her eligibility was contingent on her spouse’s enrollment in that plan—and thus she was eligible for health insurance subsidies from Vermont Health Connect. There was “no basis in law or in fact” to assume that J.H. could have compelled her husband to enroll in his employer-sponsored plan.

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