Rising healthcare costs have employers searching for sustainable alternatives to traditional group health insurance. Health reimbursement arrangements (HRAs), specifically the individual coverage HRA (ICHRA) and the qualified small employer HRA (QSEHRA), have emerged as flexible, cost-controlled options.
Now, a new trend is taking shape. States are considering new tax credits designed to further encourage HRA adoption.
In this article, we'll look at one state that has successfully implemented a tax credit and several others trying to do the same.
In this blog post, you'll learn:
The two most popular stand-alone HRAs are the ICHRA and the QSEHRA. Data collected by the HRA Council shows combined ICHRA and QSEHRA adoption increased 19% year over year from 2024 to 2025. ICHRAs are driving most of that growth, with the number of employers offering the health benefit rising by 21%.
This chart shows a quick comparison of the two benefits:
|
Feature |
Individual coverage health reimbursement arrangement (ICHRA) |
Qualified small employer health reimbursement arrangement (QSEHRA) |
|
Employer eligibility |
Large, midsize, and small businesses with at least one W-2 employee |
Small businesses with fewer than 50 full-time equivalent employees (FTEs) |
|
Employee eligibility |
Employees need qualifying individual health insurance plans |
Employees need health plans (individual or group) that provide minimum essential coverage (MEC) |
|
Eligible expenses |
Tax-free allowance for health insurance premiums and qualified out-of-pocket medical expenses |
Tax-free allowance for health insurance premiums and qualified out-of-pocket medical expenses |
|
Contribution limits |
No federally mandated contribution limits. Employers choose their own contribution |
IRS sets maximum annual contribution limits, but employers can choose a smaller amount |
|
Affordable Care Act (ACA) |
Meets the employer mandate for ALEs that offer an affordable allowance |
Employer mandate doesn't apply to small businesses |
|
Flexibility |
Employers can vary contributions based on employee class, age, and family size |
Employers can vary contributions based on employee age and family size |
Indiana House Bill 10041 positioned Indiana as the national leader in state-level HRA incentives. Effective January 1, 2024, it created the first state tax credit2 for small employers that replace traditional group health insurance coverage with an HRA, including both ICHRA and QSEHRA.
Here’s how Indiana’s tax credit works:
The design is intentional. Indiana lawmakers sought to reduce the financial hesitation small employers face when transitioning away from group health plans. The two-year structure provides a runway for employers to implement and evaluate HRAs without absorbing the full upfront cost alone.
While Indiana is the only state with an enacted credit, several others have introduced legislation or explored similar proposals.
The following table summarizes these changes in the health benefits landscape:
|
State |
Status |
Type of tax credit |
Key details |
|
Indiana |
Enacted in 2024 |
Tax credit for ICHRA and QSEHRA |
Up to $400 per covered employee in the first tax year Up to $200 per covered employee in the second tax year |
|
Ohio3 |
Introduced in 2025 Passed the House Pending in the Senate |
Proposed ICHRA tax credit |
$400 per covered employee |
|
Texas4 |
Introduced in 2025 Didn't pass |
Proposed HRA tax credit |
$400 per covered employee |
|
Georgia5 |
Introduced in 2025 Remains a proposed bill |
Proposed ICHRA tax credit |
$600 per covered employee in the first three years $400 per covered employee in the fourth year $200 per covered employee in the fifth year |
|
Connecticut6 |
Introduced in 2026 Pending legislative review |
Proposed ICHRA tax credit |
Would match employer contributions up to $1,000 per covered employee per year for the first two years. Total credits would be capped at $5 million. |
Although most of these bills did not become law, their introduction is significant. It demonstrates increasing legislative recognition that HRAs can serve as a policy tool to address small business healthcare affordability. According to KFF7, only 59% of businesses with 10 to 199 workers offered health benefits to at least some of their workers. That’s compared to 97% of organizations with 200 or more workers.
Group health insurance costs are rising faster than inflation. Employers can't keep up with skyrocketing health insurance premiums. HRAs provide a practical way to offer quality, affordable coverage.
ICHRA and QSEHRA allow employers to:
For small businesses, the benefits of an HRA are clear. However, change can feel risky, especially when leaving a familiar group health plan structure.
State tax credits aim to lower that barrier by:
Indiana’s program demonstrates how tax incentives can encourage employers to test a defined-contribution health benefit strategy.
For employers, particularly small businesses with limited budgets, this tax relief trend is worth monitoring.
If additional states adopt HRA tax credits:
As healthcare affordability remains a top concern nationwide8, expect continued experimentation with state-level incentives. If the current trajectory holds, Indiana may not stand alone for long.
State tax credits may help increase adoption, but regardless of where legislation stands, many employers are already exploring HRAs as a smarter alternative to traditional group health insurance.
At PeopleKeep by Remodel Health, we specialize in helping small and midsize employers offer HRAs with ease. With our ICHRA and QSEHRA administration software, you can provide a compliant, cost-effective health benefit to your team in just minutes each month. For larger organizations, our parent company, Remodel Health, offers ICHRA+, a solution built specifically for big businesses.
Indiana House Bill 1004 has paved the way for state-level HRA tax credits. While other states are still exploring similar incentives, the growing momentum is clear. For employers, ICHRA and QSEHRA plans offer a flexible, cost-controlled alternative to traditional group health insurance coverage. With expert support from PeopleKeep and Remodel Health, employers can confidently transition to HRAs, gaining flexibility and cost control over their healthcare benefits.
KFF: Americans’ Challenges with Health Care Costs