HHS final rule boosts ACA coverage access for DACA recipients

HHS, through CMS, has finalized policies allowing DACA recipients to be eligible to enroll in a Qualified Health Plan (QHP) through the Affordable Care Act (ACA) marketplace and a Basic Health Program (BHP).

The final rule modified the definition of “lawfully present” when used to determine eligibility for these health insurance programs. With the revision, DACA recipients will no longer be excluded from the definition and will be able to enroll in a QHP or BHP starting on November 1, 2024, if they meet other eligibility requirements.

The technical changes to the definition of “lawfully present” aim to streamline verification processes, create administrative efficiencies, and promote clarity and transparency. CMS and states will be able to improve the way they administer their programs for eligible non-citizens and ensure complete, accurate, and consistent eligibility determinations and verification processes for these individuals.

CMS estimates that 100,000 previously uninsured DACA recipients could gain healthcare coverage through the marketplace or a BHP following this rule’s finalization. The rule will also help improve coverage affordability for DACA recipients, as they will be eligible for marketplace financial assistance, including advance payments of the premium tax credit and cost-sharing reductions.

DACA recipients will qualify for a special enrollment period to enroll in a QHP through the marketplace during the 60 days following November 1. For consumers applying during this period, coverage can begin as early as December 1. Consumers who apply for coverage during December 2024 can have their coverage start as early as January 1, 2025, and those applying in January 2025 through the open enrollment period can have their coverage begin on February 1, 2025, or March 1, 2025, depending on state rules.

DACA recipients eligible for a BHP can start receiving coverage as early as November 1, 2024.

The final rule did not amend the definition of “lawfully present” for Medicaid and the Children’s Health Insurance Program (CHIP), the fact sheet noted. Section 214 of the CHIP Reauthorization Act of 2009 allows states to provide Medicaid and CHIP coverage to children and pregnant individuals who are lawfully residing in the United States.

However, CMS expects that DACA recipients who would have been eligible for Medicaid or CHIP under these proposals will be eligible for marketplace coverage with financial assistance or BHP coverage. The ACA allows non-citizens ineligible for Medicaid due to immigration status to access financial assistance through a marketplace plan, even if their income is below 100 percent of the federal poverty level.

The final rule updated the definition of “qualified non-citizen” for Medicaid and CHIP to implement statutory requirements and promote transparency around states’ eligibility policies for non-citizens.

The complete final rule can be found here.