FINAL APPEAL DECISION Appeal Decision: _xx Penalty Overturned in Full Penalty Overturned in Part Penalty Upheld Hearing Issue: Appeal of the 2015 Tax Year Penalty Hearing Date: November 21, 2016 Decision Date: February 20, 2017 AUTHORITY This hearing was conducted pursuant to the Massachusetts General Laws, Chapter 111M, Chapter 176Q, Chapter 30A and 801 CMR 1.02 and the rules and regulations promulgated thereunder. JURISDICTION Any person aggrieved by the assessment or potential assessment of the individual mandate penalty may file an appeal, pursuant to the provisions of Mass. General Laws Chapter 111M, Section 4 and 956 CMR 6.07. HEARING RECORD The appellant appeared at the hearing which was held by telephone on November 21, 2016. The procedures to be followed during the hearing were reviewed with Appellant who was then sworn in. Exhibits were marked and admitted in evidence with no objection from the appellant. Appellant testified. The hearing record consists of the appellant s testimony and the following documents which were admitted in evidence: Exhibit 1: Appeal Case Information from Schedule HC 2015 Exhibit 2: Statement of Grounds for Appeal-2015 signed and dated by Appellant on May 7, 2016 with letter in support of appeal attached Exhibit 3: Notice of Hearing sent to Appellant dated October 19, 2016 Exhibit 4: Appellant s car insurance policy, November, 2014-November, 2015 Exhibit 5: Internal Revenue Service Notice of Intent to Levy dated December 21, 2015 sent to Appellant Exhibit 6: Eversource shut-off notice dated June 10, 2015 and February 5, 2016 Exhibit 7: Notice of Cancellation of Auto Insurance Policy dated April 27, 2015 sent Page 1 of Appeal Number: PA15891
Exhibit 8: to Appellant Appellant s Credit Union bill dated February 18, 2015 for car loan FINDINGS OF FACT The record shows, and I so find: 1. Appellant, who filed a 2015 Massachusetts tax return as a married, separated person with no dependents claimed, was 32 years old for most of 2015 (Exhibit 1). 2. Appellant lived in Barnstable County, MA in 2015. Appellant was separated from Appellant s spouse from February through December (Exhibit 1). 3. Appellant s Federal Adjusted Gross Income for 2015 was $42,274 (Exhibit 1). 4. Appellant was employed in 2014, but was laid off as of January 1, 2015. After Appellant was laid off, Appellant collected unemployment compensation until the appellant found a new job in mid-march, 2015. Appellant collected about $350 a week in benefits (Testimony of Appellant). 5. Appellant was paid $20.00 an hour and worked on average 40 hours a week at Appellant s new job. Appellant had this job for the rest of the year. Appellant was not offered health insurance (Testimony of Appellant). 6. Appellant looked for health insurance coverage through the Connector in 2015, but the appellant felt the coverage was not affordable (Testimony of Appellant). 7. Appellant was uninsured all of 2015. Appellant has been assessed a tax penalty for the year; the appellant has appealed this assessment, claiming that the appellant received shut-off notices for basic utilities during 2015 and that the cost of purchasing health insurance would have caused the appellant to experience a serious deprivation of basic necessities (Exhibits 1, 2, Testimony of Appellant). 8. I take administrative notice of the financial information set forth in Tables 1 through 6 in the DOR 2015 Massachusetts Schedule HC Health Care Instructions and Worksheets. Tables 3 and 4 incorporate affordability and premium schedules adopted by the Board of Directors for the Commonwealth Health Insurance Connector Authority for 2015. Table 2 sets forth income at 300% of the Federal poverty level and Tables 5 and 6 set forth tax penalties in effect for 2015. 9. According to Table 3 of Schedule HC for 2015, an individual with no dependents, married but filing separately, with an adjusted gross income of $42,274 could afford to pay $260 per month for health insurance. According to Table 4, Appellant, age 32 and Page 2 of Appeal Number: PA15891
living in Barnstable County, could have purchased insurance for $238 per month. From January through mid-march, Appellant was collecting unemployment benefits of $350 a week, or about $1,515 per month ($18,180 a year). At this rate, Appellant could afford to pay $41 a month. The coverage would still cost $238 per month. 10. Private insurance was unaffordable for the appellant from January through March, but was affordable during the rest of the year (Schedule HC for 2015). 11. According to Table 2 of Schedule HC for 2015, Appellant, earning less than $35,010 per year from January through March would have been eligible for the Connector Care program. Once the appellant obtained employment, Appellant would have been ineligible given the appellant s income (Table 2 of Schedule HC-2015). 12. Appellant did not incur significant and unexpected increases in essential expenses as a result of domestic violence; the death of a spouse, family member, or partner who shared household expenses; the sudden responsibility for providing full care for an aging parent or other family member; or fire, flood, or other natural or manmade disaster in 2015 (Testimony of Appellant). 13. Appellant did not fall more than thirty days behind in rent payments in 2015 (Testimony of Appellant). 14. Appellant received a shut-off notice for electricity in June, 2015. In July or August, 2015, Appellant received a shut-off notice for cell phone service. The appellant also received a cancellation notice for Appellant s car insurance (Testimony of Appellant, Exhibits 6 and 7). 15. Appellant had the following monthly expenses for basic necessities in 2015: rent- $750; heat (electricity)-$140; telephone-$50; food-$400; car payment-$489; car insurance-$115; gas-$100; clothing $0. The appellant also had $1,000 in car repairs at the beginning of 2015 (Testimony of Appellant, Exhibits 4, 8). 16. When Appellant s spouse moved out, the spouse cleaned out the appellant s bank account and left the appellant owing close to $500 in overdrafts. The spouse had been responsible for paying some of the monthly bills. When the spouse left, there was a $600 balance on their electricity bill and other debts which Appellant became responsible for. These events occurred just after the appellant became unemployed (Testimony of Appellant). 17. In 2015, the appellant owed the Internal Revenue Service back taxes. Appellant paid the IRS $100 a month for about three or four months. Appellant then stopped making payments. In December, 2015, the appellant received an Intent to Terminate Installment Agreement notice from the IRS. As of December, the appellant owed $728 (Testimony of Appellant, Exhibit 5). Page 3 of Appeal Number: PA15891
ANALYSIS AND CONCLUSIONS OF LAW The issue on appeal is whether the tax penalty assessed by the Massachusetts Department of Revenue for 2015 should be waived, either in whole or in part. G.L c. 111M, 2, also called the individual mandate, requires every adult resident of Massachusetts to obtain insurance coverage [s]o long as it is deemed affordable under the schedule set by the board of directors for the Commonwealth Health Insurance Connector Authority. Residents who do not obtain insurance are subject to a tax penalty for each of the months that the individual did not have health insurance as required by the individual mandate. There is a three-month grace period to allow the taxpayer to obtain health insurance coverage or to make the transition between health insurance policies. See G. L. c. 111M, sec. 2(b) and for Tax Year 2010, Administrative Bulletin 03-10: Guidance Regarding M.G.L. c. 111M and M.G.L. c. 176Q, as implemented by 956 CMR 6.00, which interprets the 63-day gap in coverage to be three months. The Connector s regulations provide for a waiver of the tax penalty in the case of a financial hardship. See 956 CMR 6.08. Appellant had no health insurance in 2015. Appellant has been assessed a tax penalty for twelve months. The appellant appealed this assessment. Exhibits 1 and 2. To determine if the penalty should be waived in whole or in part, we must consider whether affordable insurance which met minimum creditable coverage standards was available to the appellant through employment, through the private market, or through a government-sponsored program. If affordable insurance was available, we must determine if such insurance was, in fact, not affordable to the appellant because Appellant experienced a financial hardship as defined in 956 CMR 6.08. Appellant testified that Appellant was unemployed from January through mid-march, 2015. When the appellant started work in March, Appellant was not offered health insurance. See the testimony of the appellant which I find credible. Appellant had no access to employer-sponsored insurance in 2015. According to Table 3 of Schedule HC for 2015, an individual with no dependents, married but filing separately, with an adjusted gross income of $42,274 could afford to pay $260 per month for health insurance. According to Table 4, Appellant, age 32 and living in Barnstable County, could have purchased insurance for $238 per month. From January through mid-march, Appellant was collecting unemployment benefits of $350 a week, or about $1,515 per month ($18,180 a year). At this rate, Appellant could afford to pay $41 a month. The coverage would still cost $238 per month. From January through March, a private insurance would have been unaffordable, but after the appellant obtained employment, such a plan would have been deemed affordable. According to Table 2 of Schedule HC for 2015, from January through mid-march,appellant, earning less than $35,010 per year would have been eligible for the Connector Page 4 of Appeal Number: PA15891
Care program. See Table 2 of Schedule HC-2015. Once Appellant obtained employment and was earning considerably more, Appellant would no longer have been eligible for insurance through ConnectorCare. However, Appellant would then have been eligible for a Connector Health Plan. See above. The loss of ConnectorCare coverage because of a change in income would have been a qualifying event allowing the appellant to purchase insurance, a Connector Health Plan, outside of the open enrollment period (late 2014 through January 31, 2015). See 45 Code of Federal Regulations 155.420. Affordable health insurance was available to the appellant all of 2015. From January through March, Appellant had access to ConnectorCare coverage. From April on, Appellant would have had access to a Connector Health Plan. Because of this, we need to determine whether pursuant to 956 Code of Massachusetts Regulations 6.08, a hardship exception is applicable in this matter. Pursuant to 956 CMR 6.08(1)(b), an individual who received a shut-off notice for a utility or who had utilities shut off is deemed to have experienced a financial hardship so that insurance was not affordable for the individual. Appellant testified, and I find the testimony credible, that Appellant received a shut-off notice for cell phone service in July or August. Appellant also received a shut-off notice for electricity in June, 2015. See Exhibit 6 which corroborates the testimony regarding the shut-off notice for electricity. Pursuant to 956 6.08(3), other considerations raised by the appellant may also be taken into account when determining if the appellant experienced a financial hardship which made health insurance unaffordable for the appellant. In this matter, Appellant s spouse left Appellant early in 2015, taking all of the appellant s savings from their joint bank account. Appellant was unemployed when the spouse left, leaving Appellant with numerous bills and debt to pay off. Besides expenses for basic necessities, the appellant also had to pay off a tax debt to the IRS and had to pay for a major car repair in January. In April, Appellant received a notice regarding arrearages for car insurance and possible cancellation of Appellant s policy. See the testimony of the appellant which I find to be credible and Exhibits 5, and 7. Based upon the facts summarized above and Appellant s receipt of shut-off notices for basic utilities, I determine that Appellant s penalty should be waived. Appellant experienced a hardship such that insurance was unaffordable. Appellant should note that any waiver granted here is for 2015 only and is based upon the specific facts I have found to be true and should not assume that the same determination will be made should Appellant be assessed a penalty in the future. PENALTY ASSESSED Number of Months Appealed: _12 Number of Months Assessed: _0 Page 5 of Appeal Number: PA15891
If the number of months assessed is zero (0) because your penalty has been overturned, the Connector has notified the Department of Revenue that you should NOT be assessed a penalty for Tax Year 2015. NOTIFICATION OF YOUR RIGHT TO APPEAL TO COURT If you disagree with this decision, you have the right to appeal to Court in accordance with Chapter 30A of the Massachusetts General Laws. To appeal, you must file a complaint with the Superior Court for the county where you reside, or Suffolk County Superior Court within thirty (30) days of your receipt of this decision. Cc. Connector Appeals Unit Hearing Officer Page 6 of Appeal Number: PA15891