THE TORCH: CONTENTS
May 8, 2024

Ten years after the opening of the health insurance marketplaces created under the Affordable Care Act (ACA), the Centers for Medicare & Medicaid Services (CMS) has published regulations that end the arbitrary exclusion of DACA recipients from access to affordable, quality health care. This overdue step is a critical victory for equitable access to health care, and we applaud the Biden administration for taking this essential step.

The ACA makes both U.S. citizens and lawfully present noncitizens eligible to obtain health coverage and the subsidies that make it affordable through HealthCare.gov and state-based marketplaces like Covered California. Regrettably, shortly after DACA was established, CMS issued regulations excluding DACA recipients from the ACA’s definition of “lawfully present.” In addition to making DACA recipients ineligible for marketplace plans and subsidies, the agency made them ineligible for Medicaid and Children’s Health Insurance Program (CHIP) coverage in states that have exercised the option to cover lawfully residing children and pregnant people. As a result of these exclusionary policies, DACA recipients have faced unmet health care needs and challenges for years – including crushing medical debt.

In April 2023, the Biden administration signaled that it would take steps to address these health disparities. Published just over one year later, the final rule will finally end the exclusion of DACA recipients from the definition of “lawfully present,” making them eligible for coverage and income-based financial assistance through the health care marketplaces. In states that have implemented the Basic Health Program (currently New York and Minnesota), they will be eligible for that program, depending on their income.

The regulations further clarify eligibility for certain other immigrants, including people granted Special Immigrant Juvenile Status, children seeking asylum or other humanitarian relief and applicants for adjustment to Lawful Permanent Resident status.

DACA recipients will be eligible for ACA enrollment November 1, with coverage beginning as soon as this December. This change in eligibility will require an investment in outreach and enrollment assistance from the U.S. Department of Health and Human Services (HHS) and other entities to maximize the number of people who gain coverage.

While the final rule is an important step in the right direction, there are still barriers and challenges that need to be addressed., These include the ineligibility of immigrant survivors of violence seeking U visas and deferred action, as well as the exclusion of DACA recipients from eligibility for Medicaid and CHIP in states that have elected to open those programs to lawfully residing immigrant children and people who are pregnant.

The expansion of ACA coverage to DACA recipients is a hard-fought milestone in the larger fight for health for all, but CMS can do more to expand access to critical health care coverage. We encourage President Biden, HHS, and CMS to continue expanding equitable access to health care for everyone who lives in and contributes to this country.