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CMS Final Rule Expands Health Coverage for DACA Recipients

Faridat Animashaun
May 7, 2024

On May 3, the Centers for Medicare & Medicaid Services (CMS) finalized a rule expanding access to health care coverage for Deferred Action for Childhood Arrivals (DACA) recipients.

DACA recipients now will be eligible to apply for coverage through a health care marketplace. DACA recipients also can apply for financial assistance for marketplace coverage through premium tax credits and cost-sharing reductions.

The Affordable Care Act limited eligibility to individuals who are U.S. citizens or nationals or are “lawfully present” in the United States for:

  • The Pre-Existing Condition Insurance Plan Program, which expired in 2014.
  • Qualified health plans (QHPs) on the health insurance marketplace.
  • Basic health plans (BHPs).

CMS previously issued regulations to define “lawfully present” for purposes of eligibility for these health care programs and has finalized these regulations to update the “lawfully present” definition.

This rule removes a provision that excluded DACA recipients, so they now qualify as “lawfully present” based on a grant of deferred action. If they meet other program requirements, DACA recipients will be eligible for QHPs and BHPs, as well as premium tax credits and cost-sharing reductions.

CMS did not finalize the proposal to change the definition of “lawfully present” for Medicaid and the Children’s Health Insurance Program (CHIP) under section 214 of the CHIP Reauthorization Act of 2009 (CHIPRA 214 option) at this time. The proposed change would have codified a new definition of “lawfully residing” and “lawfully present” in the Medicaid regulations, which would include DACA recipients. If these rules were finalized, DACA recipients under 21 (under age 19 for CHIP) and pregnant or postpartum individuals would have been eligible for Medicaid and CHIP benefits in states that elected this option.

Modifying “Lawfully Present” for Other Noncitizens

CMS finalized technical modifications to the “lawfully present” definition for other noncitizens who are currently eligible for QHPs, BHPs, and Medicaid and CHIP under the CHIPRA option. The changes to the definition of lawfully present will help these noncitizens maintain health coverage through changes in immigration status, visa adjustments, or applications for asylum, among other transitions. These groups include, but are not limited to:

  • Noncitizens in a valid nonimmigrant status.
  • Those granted deferred action.
  • Temporary Protected Status grantees.
  • Family Unity beneficiaries.
  • Petitioners for Special Immigrant Juveniles.

DACA recipients and other newly eligible individuals now will qualify for a special enrollment period to select a health plan through the marketplace during the 60 days following the rule’s Nov. 1 effective date.

Contact Director of Policy Rob Nelb, MPH, at rnelb@essentialhospitals.org or 202.585.0127 with questions.

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