Immigrants and the Affordable Care Act (ACA)

How the Patient Protection and Affordable Care Act affects naturalized U.S. citizens, immigrants authorized to be in the U.S., and undocumented people. Also: verification requirements under the new law.

• En español: Inmigrantes y la Ley de Cuidado de Salud a Bajo Precio (ACA)

Tips for Addressing Immigrant Families’ Concerns When Applying for Health Coverage Programs

Since January 2017, changes in immigration enforcement policy and increased enforcement activity have caused fear among immigrants and their families, undermining trust in government agencies and resulting in eligible people going without access to health care and other critical programs. Members of immigrant families may ask people helping with the health insurance application process if it is safe to apply for health coverage programs, particularly if their family includes someone who is not authorized to be in the United States. This handout provides suggestions for addressing these concerns.

FREQUENTLY ASKED QUESTIONS
The Affordable Care Act & Mixed–Immigration Status Families

Answers to frequently asked questions about mixed–immigration status families’ access to Obamacare programs. This FAQ explains, for example, who is eligible for coverage in the health insurance marketplaces created by the ACA, who in a mixed-status family is an “applicant” and who a “nonapplicant,” and who is subject to the “individual mandate” to have health insurance.

See also the PowerPoint presentations for these webinars:

• Overview of Immigrant Eligibility Policies for Health Insurance Affordability Programs
• Application Process for Health Insurance Affordability Programs for Families That Include Immigrants

“Lawfully Present” Individuals Eligible under the Affordable Care Act

Under the Affordable Care Act of 2010, individuals who are “lawfully present” in the United States will be eligible for new affordable coverage options after January 1, 2014. These options include access to “Pre-Existing Condition Insurance Plans” (PCIPs), to state or federally-run insurance exchanges, and to premium tax credits to help make health insurance more affordable. In their final rules on eligibility to enroll in the exchanges and to apply for premium tax credits, the U.S. Depts. of Health and Human Services and of the Treasury adopted the definition of “lawfully present” adopted by HHS for purposes of the PCIPs. The immigration categories described in this issue brief are considered “lawfully present” for ACA eligibility purposes.

FREQUENTLY ASKED QUESTIONS — OBAMACARE & TAXES

Immigrants, Taxes, and the Affordable Care Act

Several aspects of ACA implementation relate to the filing of taxes. Federal tax returns are used to verify income and determine eligibility for subsidies, which are provided in the form of tax credits applied to monthly premium costs. Income-eligibility for this premium tax credit is calculated based on the tax household’s income from the most recent tax year. Any under- or over-payment of subsidies is reconciled on the following year’s tax return. Federal tax returns are also used to report health insurance coverage or to claim an exemption from the individual mandate, and to assess a tax penalty if the person does not have health insurance and does not qualify for an exemption from the mandate. This FAQ explores tax-related ACA issues that are of particular concern to immigrants and their families.

Immigrants and Exemptions from the ACA Individual Mandate

The Patient Protection and Affordable Care Act generally requires people living in the United States to obtain health insurance or pay a tax penalty called a “shared responsibility payment.” The penalty increases each year and is assessed for every uninsured member of a person’s tax household who is not exempt from the so-called “individual mandate.” This FAQ provides answers to questions about the exemptions that are most commonly available to low-income immigrants and their families.

DACAmented and Undocumented Immigrants and the Obamacare Tax Penalty

The Affordable Care Act, the law that created Obamacare, requires most people in the United States to have health insurance, or claim an exemption from the requirement to have health insurance, or pay a penalty when they file their taxes. The Internal Revenue Service (the U.S.’s tax agency, which most people know as “the IRS”) calls this rule the “individual shared responsibility provision.” It is also sometimes called the “individual mandate.”

This FAQ answers questions about what DACAmented and undocumented immigrants should know about the Obamacare tax penalty rule when they file their taxes.

• En español: Inmigrantes con DACA e inmigrantes indocumentados y la multa de Obamacare
• See also the PowerPoint presentation for this webinar: Taxes and DACA: What Do I Need to Know?

Covered California Factsheets on the ACA and Confidentiality Concerns (PDF)

National – English  |  National – Spanish  |  California – English  |  California – Spanish

In partnership with NILC and other California and national organizations, Covered California has developed materials to assure immigrant and mixed-status families that it is safe to apply for health care through the federal and state-based health-care marketplaces.

INCONSISTENCIES & DATA-MATCHING PROBLEMS (ENGLISH | ESPAÑOL)
Resolving Citizenship or Immigration Status Inconsistencies or Data-Matching Problems for People Who Use the Federally Facilitated Marketplace

This issue brief answers these questions: ♦ What is meant by “inconsistencies”? ♦ What is the Federally Facilitated Marketplace doing to clear up inconsistencies? ♦ What happens if the Department of Health and Human Services can’t resolve an inconsistency? ♦ If a person receives a letter or call saying that proof is needed to verify his or her eligibility, what should the person do? ♦ What if the consumer already uploaded and mailed in copies of documents? ♦ Is there anything else the consumer can do? (This issue brief is also available in Spanish.)

• See also: Letter from advocates to U.S. Dept. of Health and Human Services Sec. Burwell about barriers to immigrants being able to get health insurance coverage under the Affordable Care Act (7/31/14). The letter discusses the following barriers: people stuck in the inconsistency or data-matching process, incorrect eligibility determinations for immigrants under 100% of the federal poverty level, identity verification, immigration status verification, and language access

The Use (and Overuse) of Credit History
Credit-based ID Verification Creates Barriers to ACA Access

Issue brief that explains how: ♦ Credit reports are used for a range of purposes beyond accessing credit. ♦ Having no credit history can lead to a loss of wealth-building opportunities. ♦ Vulnerable populations are negatively affected by no or limited credit histories. ♦ Credit history impacts access to coverage through the Affordable Care Act. ♦ Credit-based ID verification creates barriers for many immigrant families. ♦ Overreliance on credit history is putting vulnerable families at further risk.

FREQUENTLY ASKED QUESTIONS (DACA)
Exclusion of People Granted “Deferred Action for Childhood Arrivals” from Affordable Health Care

What are the health care restrictions released by the Obama administration on August 28, 2012? When do the restrictions go into effect? BEFORE August 30, 2012, what did DACA-eligible individuals have access to in terms of health care? AFTER August 30, 2012, what do DACA-eligible individuals have access to in terms of health insurance? Do the DACA health care restrictions affect all individuals granted deferred action? What are the key policy concerns about the health care restrictions? And more.

• See also this 2-pager: Health Care for DACA Grantees (PDF)

NILC Comments on ACA Implementation Regulations

National Immigration Law Center comments on implementation regulations from the Centers for Medicare and Medicaid Services (CMS) and the Internal Revenue Service (IRS).

More Resources (non-NILC)

More resources that deal with implementation of the Affordable Care Act, from organizations other than NILC as well as from U.S. Immigration and Customs Enforcement (ICE) and the U.S. Department of Health and Human Services, are available from our More ACA Resources webpage.