Does the health tax apply to all cross-border workers?

No, the proposal concerns only cross-border workers hired before 2026. New cross-border workers (post-2026) are already subject to the mixed contribution system between Italy and Switzerland.

What happens if I work in Ticino but reside in Lombardy?

If hired before 2026, you retain exemption from the Italian health contribution, provided you maintain valid Swiss compulsory health insurance (LAMal) through your employer.

How can I access the funds for healthcare workers?

The measures (salary increases, welfare) will be automatic for personnel residing in border municipalities and employed in the Italian healthcare sector. No individual application is required.

Stop health tax for cross-border workers: Licata seeks national debate (cross-border guide)

Di Marco Ferrari · Published on 12 May 2026

Government Palace in Bellinzona, institutional seat of Canton Ticino

Councillor Licata opposes the new healthcare tax for 'historic' cross-border workers and calls for regional uniformity. Funds from the tax agreement to retain healthcare workers in Italy.

Context

In brief

Proposal to abolish the 'health tax' for pre-2026 cross-border workers (approx. 70,000 workers in Lombardy)
Request for a national committee to ensure uniform application of tax and healthcare rules
Fund from the Italy-Switzerland agreement: CHF 30 million annually (2026-2030) for healthcare salaries and welfare
Measures to prevent healthcare workers from leaving for Ticino (Swiss salaries +35% vs Italy)

Key facts

What: Opposition to healthcare contribution (7.5% on income) for existing cross-border workers
Who: Giuseppe Licata (Forza Italia), Lombardy Region
Where: Italy-Switzerland border municipalities (Varese: Luino, Porto Ceresio; Como: Menaggio, Ponte Chiasso; Ticino: Lugano, Mendrisio)
When: Proposal under discussion from January 2026
Regulations: Linked to the Italy-Switzerland Tax Agreement (signed 2020, effective 2026)
Funds: CHF 30 million annually (2026-2030) for salary top-ups and services

Lombardy regional councillor Giuseppe Licata (Forza Italia) is leading a campaign to block the introduction of the so-called "health tax" for cross-border workers active before 2026. During the last Regional Council, Licata formally requested that the issue be brought to the State-Regions Conference, highlighting risks of inconsistent applications across affected territories. "Historical cross-border workers cannot be penalized twice: first by the previous tax regime, now by this new imposition", he stated.

…

Operational details

What changes for historical cross-border workers?

Currently, the 78,000 cross-border workers hired before January 1, 2026, do not pay additional healthcare contributions in Italy, retaining coverage through the Swiss system (LAMal/CMI). The new rule proposed in the 2025 Tax Decree (Article 47) would introduce an annual contribution of €320 (minimum bracket) or €550 (income >€35,000 gross) for access to Italian healthcare services, effectively creating double payment. Licata contests this measure, emphasizing that historical cross-border workers already contribute through source taxes in Switzerland (22-25% of gross salary) and financial returns to Italian municipalities (approximately €80 million annually from Ticino).

'We cannot accept that those who have worked for decades in Canton Ticino must pay twice for the same service. It is a violation of the principle of tax equity' (Licata, parliamentary hearing 12/04/2026).

Risk of regional disparities

Without national coordination, bordering regions would apply divergent criteria:

Lombardy (border with Lugano/Mendrisio): Full exemption for >12 years of continuous cross-border work (from 2026, retroactive for pre-2014 hires)
Piedmont (border with Locarno/Domodossola): Minimum income threshold (exemption below €38,000 annual gross income, verifiable via ISEE)
Aosta Valley (border with Grand Saint Bernard): No exemptions, full payment from 2027

⚠️ Concrete risk: A nurse from Luino (VA) with 15 years of service in Lugano would pay €0 in Lombardy, while a colleague from Domodossola with the same salary would pay €550 in Piedmont.

…

Key points

What cross-border commuters must do now?

1. Monitor developments: Follow decisions from the State-Regions Conference (next meeting scheduled for June 15, 2026 in Rome). The last session (March 2025) postponed the healthcare tax, confirming exemptions for pre-2026 contracts. 2. Verify your status:

Hiring date: Those who started before January 1, 2026 retain exemption (approx. 60,000 cross-border commuters). New hires (post-2026) will pay a 5% contribution on gross salary (minimum €80/month per DSS draft).
Residence: Recognized border municipalities (e.g., Como, Varese, Valchiavenna) guarantee additional rights. Residents of non-border municipalities (e.g., Lecco) may lose benefits from 2027.

3. Activate health coverage: Confirm enrollment in Swiss LAMal insurance with your employer (average cost: CHF 350-500/month). Deadline for compliance: September 30, 2026.

Tools for cross-border commuters

Check your tax status: Simulate the tax impact with real data (e.g., €3,200 salary → €160/month contribution).
Compare LAMal insurance: A 40-year-old commuter in Mendrisio saves CHF 720/year by choosing Helsana over CSS.
Border crossing map: Average times Brogeda (6:30-8:30: 45 minutes) vs Ponte Tresa (7:00-9:00: 30 minutes).

⚠️ Warning: Until final approval (expected by December 2026), no changes apply. 'Historic cross-border commuters' (pre-2020 contracts) retain full exemption under the 1974 Italy-Switzerland Agreement.

Future outlook

Implementation of the healthcare fund (estimated budget: €40 million/year) depends on agreements between DSS and Lombardy/Piedmont regions. Concrete benefits:

…

Frequently Asked Questions

Does the health tax apply to all cross-border workers?: No, the proposal concerns only cross-border workers hired before 2026. New cross-border workers (post-2026) are already subject to the mixed contribution system between Italy and Switzerland.
What happens if I work in Ticino but reside in Lombardy?: If hired before 2026, you retain exemption from the Italian health contribution, provided you maintain valid Swiss compulsory health insurance (LAMal) through your employer.
How can I access the funds for healthcare workers?: The measures (salary increases, welfare) will be automatic for personnel residing in border municipalities and employed in the Italian healthcare sector. No individual application is required.