For DACA Grantees, Health Insurance is (Only) a Dream

By Dinah Wiley

[Update:  In August 2022, the Biden administration codified the DACA program in regulation. The regulation did not change health insurance for DACA grantees.  For current information on DACA, visit the National Immigration Law Center.]

We receive a lot of questions about the health insurance eligibility of non-citizens with a special Deferred Action status called Deferred Action for Childhood Arrivals (DACA).  These uninsured immigrants are an exception to the general rule that non-citizens who are “lawfully present” are eligible for coverage under the Affordable Care Act.  They are also the only immigrants with Deferred Action who are not eligible.

The Obama Administration created the DACA program to provide certain undocumented youth and young adults, sometimes called “DREAMers,” with the chance to work and to continue their education in the U.S. without fear of deportation (“removal”). Non-citizens granted DACA are eligible for a Social Security number and an employment authorization document (EAD, or “work permit”).  The exclusion of DACA grantees from health insurance was issued as federal regulations and guidance effective August 30, 2012.

Generally, non-citizens with Deferred Action are not [“qualified” immigrants] and so are not eligible for full-scope Medicaid and CHIP.  Additionally, those granted Deferred Action for Childhood Arrivals are also not eligible for affordable health insurance options that are available to other non-citizens who have Deferred Action.

Under the policy, DACA grantees are not eligible to purchase health insurance in a Marketplace, even at full cost, and they are not eligible for federal tax credits to make private health insurance in the Marketplace affordable.  They are not eligible for the CHIPRA sec. 214 state option to cover lawfully residing children and/or pregnant women.   Accordingly, DACA individuals are exempt from the individual responsibility requirement to have health insurance (the “mandate”).

DACA individuals have the same eligibility for health care and coverage as undocumented immigrants have.  They may be eligible for a separate, state-funded program available regardless of immigration status. After an individual’s DACA expires, they still may be eligible for state health programs.

If their state elects a CHIP option to provide prenatal care regardless of status, then pregnant DACA grantees may receive care.  A map and a chart  maintained by the National Immigration Law Center provides detailed information on state coverage programs.

Other access to care available to undocumented immigrants and to DACA grantees include limited emergency services paid for by Medicaid, including labor and delivery for childbirth.  Safety net programs that are available to all regardless of immigration status include immunizations, treatment at Community Health Centers and other Federally Qualified Health Centers (FQHCs), Migrant Health Centers, financial assistance or charity care at hospitals, insurance at full cost offered outside the Marketplaces, and employer-sponsored health insurance, if offered. Over 50 percent of DACA grantees became employed at a job that provided health insurance or other benefits; despite DACA termination, their health insurance should remain in effect as long as the employment lasts, after which they can continue insurance through COBRA.  Finally, a number of local jurisdictions provide health services for their residents regardless of immigration status, including some places where many DACA grantees live, e.g.: Los Angeles County, CA; Cook County, IL (includes Chicago); New York City, NY; and Washington, DC.