Health coverage provides peace of mind and allows individuals to focus on their wellbeing, yet Dreamers often lack access to affordable health care as they do not qualify for either Affordable Care Act Marketplace coverage or Medicaid under current rules.
To address this problem, the Biden Administration plans on enacting a rule by the end of this month that will enable Dreamers access ACA marketplace plans and financial assistance as well as state Medicaid programs.
What Is DACA?
Deferred Action for Childhood Arrivals (DACA), established in 2012, provided temporary relief from deportation and work authorization to young immigrants who entered the US as children. To be eligible for DACA, individuals needed to meet certain criteria – these included being under 31 years old on June 15, 2022; having entered before turning 16; living continuously since arrival here until age 16; possessing either a high school diploma or equivalent; passing a GED test; not being convicted of a felony or significant misdemeanor conviction; not being an immediate threat to national security or public safety – in order to be eligible.
DACA recipients play a vital role in our economy, contributing billions in earnings and paying taxes; aiding communities, helping provide services, and contributing positively as members of society. Unfortunately, due to their immigration status they have been denied affordable health coverage – forcing many to wait until they become sick or injured before seeking medical care, which puts their health at risk and negatively affects communities of color disproportionately.
As an attempt at reconciliation, in 2021 the Biden administration unveiled a plan that would enable DACA recipients to gain health coverage by enrolling them into state-run marketplaces created under the Affordable Care Act (ACA), Medicaid, CHIP or private insurers participating in its exchanges. Furthermore, financial assistance plans would be extended by qualifying DACA recipients for premium and cost sharing assistance plans.
Though still being challenged, this announcement marks an important step toward helping families across the nation avoid costly health complications and live healthier lives. “We must do all we can to make sure frontline workers and families, including those with DACA status, have access to health care they require,” stated Rep. Joaquin Castro (D-Texas), who led Congress’ effort in passing this legislation.
As we emerge from COVID-19 public health emergency, it has never been more important to ensure everyone has access to affordable and accessible health insurance coverage. The Biden administration’s new proposed rule is an encouraging sign and we hope it will soon be approved.
How Does DACA Work?
President Biden took steps in 2021 to preserve and strengthen DACA while waiting for congressional action on it. While doing so, he called upon lawmakers to provide Dreamers with access to quality health insurance plans as a pathway towards citizenship.
The administration’s latest proposal would address this latter concern by altering how DACA recipients are treated when it comes to accessing CMS programs such as the Affordable Care Act Marketplace, Basic Health Program and Medicaid. Under its new rule, Dreamers would qualify for these programs under a more inclusive definition of lawfully present than is currently used to determine eligibility.
Before the rule change, Dreamers could only access health coverage programs through enrolling through their employer. While this remains an effective strategy for some workers in the private sector or without employer-based health coverage plans. A recent study determined that around 34,000 DACA recipients did not have access to either the Affordable Care Act marketplace or financial assistance to purchase one of its plans.
If the Biden administration’s proposed rule becomes official, it will remove this barrier and open the way for DACA recipients to purchase health coverage through the Affordable Care Act Marketplace, obtain financial aid assistance to cover plan premiums, and apply to Medicaid/CHIP plans expanded under ACA’s expansion rules in states that expanded these programs. This will provide them with reliable health coverage while giving them peace of mind that comes from knowing they will receive medical care when needed.
Policy changes made under President Obama are a boost to both Dreamers and Democrats who advocated for access to health coverage for DACA recipients, but don’t address how DACA recipients should ultimately gain legal status in America; that should be handled by Congress, while HHS has little support as an agency responsible for crafting immigration policies. It appears likely that court litigation will determine DACA’s fate before being taken up by the Supreme Court by 2024 if found unlawful.
Can DACA Recipients Get Health Insurance?
Since 2012, President Obama’s Deferred Action for Childhood Arrivals (DACA) program has protected more than 580,000 undocumented immigrants from deportation through DACA. Unfortunately, however, DACA doesn’t provide permanent legal status or a path toward U.S. citizenship, meaning these Dreamers do not qualify for most federal benefits such as health insurance through the Affordable Care Act Marketplace or Medicaid programs. According to NBC News reports that Biden Administration proposal announced on Thursday would overcome these hurdles by changing how lawfully present means “lawfully present” definition so Dreamers gain access.
The Centers for Medicare and Medicaid Services’ proposal will enable DACA recipients to enroll in Affordable Care Act marketplace plans, Basic Health Program coverage and certain Medicaid and CHIP coverage through the marketplace, while applying for financial assistance such as premium tax credits and cost-sharing reduction payments through it.
DACA recipients currently can obtain health coverage through employers or unions that provide insurance benefits or through buying private insurance on the Affordable Care Act Marketplace, while family members may claim them as dependents on their policies. Some may use community health clinics or cash pay options; however, such alternatives often incur high out-of-pocket expenses given that many DACA recipients live below poverty lines.
As well as eliminating this barrier to health insurance for Dreamers, this proposal will enable them to take full advantage of both the upcoming marketplace open enrollment period in 2024 and special enrollment period that applies only to newly eligible people for marketplace plans. They could access federally subsidized marketplace plans offered by employers and schools or universities as well as wider ranges of mental and dental health services.
Before implementation, this rule must first receive approval by the Trump administration’s Office of Management and Budget and is expected to go into effect sometime after November 2023, barring any intervening Supreme Court orders or district court reviews that deem DACA unlawful. Should that occur, those enrolled in DACA would likely lose their work authorizations as well as potentially face deportation proceedings.
Can DACA Recipients Get Medicaid?
Many young people protected by DACA are at risk of not having access to affordable, quality health care. They’re three times more likely to be uninsured than US citizens of similar age and encounter barriers when seeking coverage, such as lack of knowledge about available coverage options or fear of deportation or rejection from providers, language/literacy challenges etc.
The Biden administration is working to improve health outcomes by addressing barriers that make enrollment in health insurance harder for Dreamers. HHS Secretary Xavier Becerra recently introduced legislation asking Congress to expand the definition of lawful presence under the Affordable Care Act, including DACA recipients, to allow them to enroll in the Marketplace, access financial assistance to make premiums more affordable, as well as become eligible for Medicaid and Children’s Health Insurance Program – this proposal also ensures their eligibility is verified when applying.
However, the proposal is currently subject to federal court review in Texas by a judge who has determined that President Obama lacked authority for DACA creation. If that ruling holds up, DACA could be terminated with people losing both work authorization and employer-based health benefits – leading to job loss and deportation and having major economic and health ramifications on those dependent upon DACA for livelihood reasons.
As DACA recipients access health care, some states are taking steps to assist them. New York provides health coverage to anyone meeting its criteria – this includes DACA recipients. New York residents can apply for Child Health Plus or Medicaid without disclosing their immigration status and having it affect their eligibility to receive these programs. Additionally, in New York applicants’ immigration status is kept private while using these services – an important step toward providing health insurance to all New Yorkers regardless of immigration status. New Mexico and other states are considering similar steps to expand coverage among their residents.