“Lawfully Present” Individuals Eligible Under the Affordable Care Act

Under the Affordable Care Act of 2010 (ACA),1 individuals who are “lawfully present” in the United States have been eligible for new affordable coverage options since January 1, 2014. In July 2010, 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). In August 2012, the definition was revised to exclude individuals granted deferred action under the Deferred Action for Childhood Arrivals Program (DACA).

This definition, codified at 45 C.F.R. section 152.2, generally tracked the definition used in Medicaid and the Children’s Health Insurance Program (CHIP) to provide affordable coverage to low-income children and pregnant people who are lawfully residing in the U.S.5 Under the PCIP 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. HHS and the U.S. Department of Treasury adopted the PCIP definition of “lawfully present” in their final rules on eligibility to enroll in the state or federally-run health insurance exchanges and to apply for premium tax credits to help make health insurance affordable.

In May 2024, HHS revised this definition for purposes of ACA coverage and subsidies to include DACA recipients, and to clarify eligibility for certain other groups. The new rules, to be codified at 45 C.F.R. §155.20, will become effective on November 1, 2024.

The immigration categories described in this guide are considered “lawfully present” for ACA eligibility purposes.

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