The President’s Immigration Announcement: What Do Health Policy Wonks Need to Know?

Last Thursday, President Obama announced immigration reforms that will provide up to five million people with relief from deportation and work authorization. While the reforms will do much to alleviate the constant fear of separation that many immigrant families face, most people included in the reforms will not be eligible for federal health coverage affordability programs. Read on to get a quick take on what the reforms are and what they mean in terms of health coverage.

Who do the immigration reforms help?

Obama announced a new deferred action program, “Deferred Action for Parental Accountability” (DAPA), and expanded the existing “Deferred Action for Childhood Arrivals” (DACA) program. Eligibility for both programs will be granted on a case-by-case basis. This means that even if an individual meets the requirements, immigration officials will decide whether or not to grant it. It is also a temporary status, generally valid for three years, but can be renewed. To learn more, see materials from the National Immigration Law Center.

DAPA – The new program, “Deferred Action for Parental Accountability” (DAPA) will allow undocumented people who have a U.S. citizen or lawful permanent resident child to apply for work authorization and protection from deportation, if the person has been in the U.S. since January 1, 2010. Individuals cannot have been convicted of certain criminal offenses. It is estimated that 4.1 million people will qualify for this program.

Expanded DACA – The “Deferred Action for Childhood Arrivals” (DACA) program will be expanded to cover people who entered the U.S. before their sixteenth birthday and have lived continuously in the U.S. since January 1, 2010. People who “aged out” of DACA by being older than age 31 on June 15, 2012, are now eligible to apply, regardless of how old they are now. Individuals also cannot be convicted of certain criminal offenses. An estimated 300,000 people will benefit from these changes.

When will these new immigration programs start?

No one can apply for these new programs yet. The expanded DACA program is likely to start accepting applications in three months (February 20, 2015), and the DAPA program in six months (May 20, 2015).

Are people in these new and expanded immigration programs eligible for federal health coverage programs?

While it has not been confirmed in writing, an Administration spokesperson on a conference call last week answered my question about access to health coverage for those granted deferred action in these new programs. The spokespeople said that, consistent with the Administration’s DACA policy, people granted DAPA or expanded DACA will NOT be eligible for federal health coverage programs. So, in essence, people granted DAPA or DACA will continue to have the same eligibility for health care and coverage that undocumented immigrants have. Here’s a closer look at what this looks like:

Medicaid/ CHIP – Individuals with Deferred Action are not “qualified immigrants” and so are not eligible for full-scope Medicaid and CHIP.  Individuals may be eligible for Medicaid for emergency services.

Marketplace – The Administration is planning to exclude people with expanded DACA and DAPA from buying health coverage on the marketplace even at full cost, and receiving federal premium tax credits on the marketplace, just like with the original DACA program. The Administration’s DACA policy is an exception to the general rule that non-citizens who are “lawfully present” and have deferred action status are eligible for coverage under the ACA. For the backstory on DACA and health insurance, see my colleague’s blog here.

Employer Coverage – There is some hope that the work authorization will allow people granted DACA or DAPA to obtain jobs that provide health insurance benefits. However, many people in low-wage, part-time and seasonal jobs will continue to be left out of employer-sponsored health insurance or unable to afford their required share of the premiums.

Individual market coverage outside the marketplace – Some individuals enrolled in DACA or DAPA may be able to afford individual market insurance outside the marketplace and may feel more comfortable doing so with work authorization and protection from deportation.

What can you do to help DAPA or DACA enrollees gain coverage?

Advocate for your state to cover DACA or DAPA recipients with state funds. A handful of states and localities—California, DC, and NY— allow low-income DACA recipients to enroll in health insurance that is not paid for with federal funds. Additional states provide coverage to lawfully residing children and pregnant women. For more information, see NILC’s table about health coverage for immigrants in various states.

Work to ensure that the children of DAPA recipients enroll in Medicaid or CHIP. By definition, those eligible for DAPA will have citizen or lawfully residing children. Our recent analysis on the high rates of uninsurance among Hispanic children highlighted that two-thirds of uninsured Hispanic children are eligible for Medicaid or CHIP but unenrolled. And, while Hispanic children are the single largest group, there are additional citizen children of other races and ethnicities in similar situations. By removing the threat of deportation, Obama’s administrative action effectively reduces a barrier to coverage for children who are eligible for Medicaid or CHIP coverage but unenrolled. Parents supported by relief from deportation will be less afraid of approaching the government and more likely to sign up for health coverage for their children, With potentially 4 million parents eligible for DAPA, this policy change could lead to millions more children gaining coverage. And with 29 states and DC offering children coverage with no five-year waiting period, many lawfully residing children are likely to be eligible as well. I plan to write more as more information is available about ways to encourage the applications for DAPA to go hand-in-hand with health coverage for children.

While Obama’s immigration reforms provide a needed respite from fears of family separation and needed work authorization, they do NOT come with the ability to enroll in affordable health insurance. What the reforms do provide is a welcome mat that can help the U.S. cover more uninsured children who have immigrant parents.