Following up on President Biden’s announcement earlier this month, HHS released a proposed rule that would make DACA grantees eligible for Marketplace coverage and some Medicaid/CHIP coverage. This is an important step in the right direction – removing unnecessary and unjustified barriers to health coverage for DACA grantees – but there is more work to do to make health coverage more universally available. First, let’s focus on the good news.
As a reminder, DACA stands for Deferred Action for Childhood Arrivals and essentially provides people who moved to the U.S. as young children with two benefits: deferred action and employment authorization. Deferred action means that the Department of Homeland Security (DHS), exercising its prosecutorial discretion, has directed immigration enforcement agencies to consider DACA grantees a “low priority” for removal proceedings and essentially pause deportations for program participants for a period of 2 years, subject to renewal.
DACA grantees aren’t the only group with a deferred action immigration status, but under current law, they are the only deferred action group specifically excluded from shopping for health insurance on the Marketplace or qualifying for premium tax credits. Medicaid and CHIP eligibility rules are more complex – noncitizens must generally be “lawfully residing” and have “qualified status” for at least 5 years before becoming eligible. States have the option to waive the 5-year waiting period and cover all lawfully residing children and pregnant people, but like the Marketplace, DACA grantees are specifically excluded from this coverage under current subregulatory guidance.
The proposed rule would do away with these confusing and conflicting definitions by clarifying that if a person, such as a DACA grantee, has deferred action and is considered “lawfully present” by DHS, they will also be considered “lawfully present” by HHS, and if they meet state residency requirements, “lawfully residing.” This would open up Marketplace eligibility across the country for all ages and Medicaid/CHIP eligibility for children and pregnant people in states that have elected the option, plus eligibility for the Basic Health Program (BHP) in Minnesota and New York. The rule also makes other important clarifications and simplifications to the Marketplace, BHP, and Medicaid/CHIP eligibility rules for immigrant groups and codifies key definitions. Comments on the rule are due June 23, 2023.
These changes are important because DACA grantees are much more likely than U.S.-born individuals in their age group to be uninsured – KFF estimates that 47% of likely DACA-eligible individuals ages 15-41 are uninsured compared to just 10% of U.S. born individuals in the same age range. Having health insurance coverage improves access to care and provides financial security. Moreover, many DACA grantees are parents and when parents have health insurance, they are better able to care for their children because they are healthier and more financially secure, and their kids are more likely to have health insurance too.
But, as I mentioned, there is more that needs to be done to provide universal access to coverage. The complex citizenship-related Medicaid/CHIP eligibility rules ought to be revisited. States are making progress with universal health coverage regardless of citizenship status, especially for children, but federal rules haven’t kept up. We have argued that Congress should eliminate the citizenship-related Medicaid/CHIP eligibility rules to help ensure that all children have health coverage. Congress could also consider more incremental changes that would greatly improve the current system, such as eliminating the extra step to have “qualified” status and eliminating the 5-year waiting period.
The benefits of having Medicaid/CHIP as a child extend well into adulthood – leading to better health and educational outcomes, better jobs, and higher tax contributions. Immigrant-inclusive policies would extend these benefits to all children, narrowing the current coverage disparities and advancing health equity. Unfortunately, there is only so much the Administration can do on its own. Will Congress do its part?