What is the impact of the health tax for Swiss-Italian border workers?

The health tax is not a Ticino tax: it is a contribution to the Italian National Health Service set by Italian Law 213/2023 (art. 1, paragraphs 237-239) and paid to the Italian region of residence. Use our calculation tools to estimate the impact on your net salary.

Which Italian border municipalities could be directly affected by a blockade of the ristorni (tax refunds)?

No figure is given here: the current number of municipalities receiving ristorni must be verified for the relevant year with the competent authorities.

How to calculate the health tax amount for a border worker earning CHF 3,500 per month?

There is no fixed percentage of gross pay and no ceiling in francs. Law 213/2023 requires the Italian region of residence to set each year a rate between 3% and 6% of the net salary received in Switzerland, progressive with net income and family dependants, with a minimum of 30 euros and a maximum of 200 euros per month worked. The amount for CHF 3,500 gross therefore depends on the net salary and on the rate set by the region.

What are the tax consequences if the joint committee does not resolve the health tax dispute?

The 2020 agreement does not refer disputes to a court: Article 6 requires the competent authorities to resolve questions of interpretation and application by mutual agreement, including through the joint commission, and lets an individual taxpayer submit a case under Article 26 of the double taxation convention. The health contribution remains an obligation under Italian law: if payment or notification is omitted, the monthly minimum and maximum can be doubled (Italian Ministry of Health decree of 14 November 2025).

Where can I find the form to request reimbursement of an excess health tax paid in 2023?

There is no ACIF form for such a refund: ACIF is an association of municipalities and does not collect the contribution, which is not a cantonal tax. The contribution applies from 2024, so nothing was due for 2023; it is paid each year to the Italian region of residence through the electronic payment tools set by the decree of 14 November 2025, and any request must be addressed to that region.

Health Tax: Tensions Rise Between Italy and Ticino

Di Laura Bianchi · Published on 17 February 2026 · Updated on 26 September 2026

Panorama of Bellinzona with medieval castles against the Ticino Alps backdrop.

The health tax continues to generate debate and tensions between Italy and Ticino. Statements by Lorenzo Quadri and reactions from border mayors.

Context

TL;DR

Tensioni tra Italia e Ticino per la tassa salute
Quadri propone di bloccare i rimborsi all'Italia
Mastromarino invita a usare canali diplomatici

Key facts

Cosa: Tassa salute per compensare costi sanitari per lavoratori frontalieri
When: 2020 agreement: joint commission and mutual agreement procedure
Dove: Canton Ticino, Svizzera e Italia
Chi: Lorenzo Quadri (Lega) e Massimo Mastromarino (ACIF)
Importo: Rimborso Svizzera-Italia nel 2024: oltre 120 milioni di franchi
Scadenza: Nessuna scadenza specificata per la risoluzione della controversia

The issue of the health tax is straining relations between Italy and the Canton of Ticino. Recent statements by Lorenzo Quadri, a national councilor of the Lega, suggesting to "turn off the taps to Italy" as retaliation for the health tax, have provoked strong reactions. Massimo Mastromarino, mayor of Lavena Ponte Tresa and president of ACIF (Association of Italian Border Municipalities), has sharply criticized these statements, stressing that this is not the way to resolve differences. According to Mastromarino, it is essential to follow the institutional channels provided for in the new fiscal agreement, in particular Article 6, which provides for the joint commission and the mutual agreement procedure for disputes. The 2020 agreement provides for the joint commission and the mutual agreement procedure; without an official release, this article does not assign a date or outcome to a specific meeting.

Operational details

The health tax, i.e. the contribution to the Italian National Health Service introduced by Italy in the 2024 budget law and paid to the Italian region of residence, has become a significant point of friction. The Lega dei Ticinesi seems intent on using the issue of blocking refunds as leverage to exert pressure on Italy. However, Mastromarino warns that this strategy could be counterproductive and calls for the use of diplomatic channels to find a shared solution. It is important to remember that refunds represent a fundamental resource for Italian border municipalities. The financial compensation for 2024, paid by Switzerland to Italy in the first half of 2025, exceeded 120 million francs, a record that testifies to the importance of these funds for local administrations.

Key points

For cross-border workers, it is essential to stay informed about the developments of this situation and understand how the health tax and possible retaliations may affect their finances. We invite you to regularly consult our website for updates, analyses, and practical advice. Use our calculation tools to estimate the impact of the health tax on your net salary and evaluate the different options available to optimize your tax situation. Remember that clarity and awareness are essential to best face the challenges related to cross-border work. Sources: Law no. 213 of 30 December 2023, art. 1, paragraphs 237-239, Italian Ministry of Health decree of 14 November 2025, Official Gazette no. 293 of 18 December 2025 and Italy-Switzerland agreement of 23 December 2020 on cross-border workers, articles 6 and 9.

Frequently Asked Questions

What is the impact of the health tax for Swiss-Italian border workers?: The health tax is not a Ticino tax: it is a contribution to the Italian National Health Service set by Italian Law 213/2023 (art. 1, paragraphs 237-239) and paid to the Italian region of residence. Use our calculation tools to estimate the impact on your net salary.
Which Italian border municipalities could be directly affected by a blockade of the ristorni (tax refunds)?: No figure is given here: the current number of municipalities receiving ristorni must be verified for the relevant year with the competent authorities.
How to calculate the health tax amount for a border worker earning CHF 3,500 per month?: There is no fixed percentage of gross pay and no ceiling in francs. Law 213/2023 requires the Italian region of residence to set each year a rate between 3% and 6% of the net salary received in Switzerland, progressive with net income and family dependants, with a minimum of 30 euros and a maximum of 200 euros per month worked. The amount for CHF 3,500 gross therefore depends on the net salary and on the rate set by the region.
What are the tax consequences if the joint committee does not resolve the health tax dispute?: The 2020 agreement does not refer disputes to a court: Article 6 requires the competent authorities to resolve questions of interpretation and application by mutual agreement, including through the joint commission, and lets an individual taxpayer submit a case under Article 26 of the double taxation convention. The health contribution remains an obligation under Italian law: if payment or notification is omitted, the monthly minimum and maximum can be doubled (Italian Ministry of Health decree of 14 November 2025).
Where can I find the form to request reimbursement of an excess health tax paid in 2023?: There is no ACIF form for such a refund: ACIF is an association of municipalities and does not collect the contribution, which is not a cantonal tax. The contribution applies from 2024, so nothing was due for 2023; it is paid each year to the Italian region of residence through the electronic payment tools set by the decree of 14 November 2025, and any request must be addressed to that region.