“Lawfully Present” Individuals Eligible under the Affordable Care Act
Under the Affordable Care Act of 2010 (ACA), individuals who are “lawfully present” in the United States are eligible to enroll in the health insurance marketplace and may qualify for premium tax credits and other affordable coverage options. In July 2012, the U.S. Department of Health and Human Services (HHS) defined “lawfully present” for purposes of eligibility for the ACA’s high-risk insurance pools, referred to as the Pre-Existing Condition Insurance Plans (PCIP). This definition, codified at 45 C.F.R. section 152.2, generally tracks the definition used in Medicaid and the Children’s Health Insurance Program (CHIP) for states that elect to cover lawfully residing children and pregnant people. Under HHS’ definition, “lawfully present” individuals include not only those classified as “qualified” immigrants, but several other categories of non–U.S. citizens who have permission to live and/or work in the U.S. This piece describes the immigration categories that are considered “lawfully present” for ACA eligibility purposes.