Jeffrey Wade
DACA (Deferred Action for Childhood Arrivals) recipients have been excluded from health insurance coverage under the Affordable Care Act (ACA) for years. However, recent federal rule changes have made it possible for DACA recipients to access health insurance plans and financial assistance. Starting on November 1, 2024, DACA recipients became eligible to enroll in private health insurance plans through the health insurance marketplaces created by the ACA, such as HealthCare.gov. This change in definition of lawfully present for ACA purposes allows DACA recipients to access affordable, quality health insurance. Despite this progress, a federal judge's order on December 9, 2024, blocked certain DACA recipients in 19 states from accessing ACA coverage due to a lawsuit.
| Characteristics | Values |
|---|---|
| DACA recipients' eligibility for federal Medicaid | No change or expansion in eligibility |
| Health coverage options available | Moms & Babies, Medicaid Presumptive Eligibility (MPE), Family Planning Presumptive Eligibility (FPPE) Program, All Kids |
| Privacy protection | Yes |
| Enrollment period | Special enrollment period in 2024; November 1, 2024, to December 1, 2024; November 2024 to January 1, 2025; January 2025 to February 1, 2025, or March 1, 2025 |
| Eligibility criteria | Income, immigration status, and other requirements |
| States blocking DACA recipients from enrolling | Alabama, Arkansas, Florida, Idaho, Indiana, Iowa, Kansas, Kentucky, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, South Carolina, South Dakota, Tennessee, Texas, and Virginia |
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What You'll Learn
- DACA recipients can access affordable health insurance through government health care marketplaces
- DACA recipients can receive financial help if they qualify
- DACA recipients are eligible for Health Insurance Marketplace coverage with financial assistance
- DACA recipients can enrol in private health insurance plans through the Affordable Care Act
- DACA recipients are eligible for a special enrollment period to select a health plan
DACA recipients can access affordable health insurance through government health care marketplaces
After years of exclusion, DACA recipients can now access affordable, quality health insurance through the government's health care marketplaces. This change is the result of a final rule published by the US Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (CMS). The rule modifies the definition of "lawfully present" for eligibility for enrollment in a Qualified Health Plan (QHP) through the Health Insurance Marketplace.
Starting November 1, 2024, DACA recipients who meet the eligibility requirements can enroll in a QHP through the Marketplace with financial assistance. This includes Advance Payments of the Premium Tax Credit (APTC) and cost-sharing reductions (CSRs). The Affordable Care Act (ACA) allows noncitizens who are ineligible for Medicaid due to their immigration status to access financial assistance through a Marketplace plan, even if their income is below 100% of the federal poverty level.
DACA recipients can compare plans and costs on websites like healthcare.gov, although their final subsidized premiums and reduced copayments will depend on their income. They can also receive help with the enrollment process from Enrollment Navigators, community-based organizations, and brokers or agents.
However, it is important to note that due to a lawsuit, DACA recipients in 19 states are blocked from enrolling in Marketplace coverage: Alabama, Arkansas, Florida, Idaho, Indiana, Iowa, Kansas, Kentucky, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, South Carolina, South Dakota, Tennessee, Texas, and Virginia.
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DACA recipients can receive financial help if they qualify
DACA (Deferred Action for Childhood Arrivals) recipients can receive financial help if they qualify. Starting November 1, 2024, DACA recipients who meet the eligibility requirements will be able to enroll in private health insurance plans through the health insurance marketplaces created by the Affordable Care Act (ACA). This means that, apart from the 19 states implicated in the KS v. U.S. lawsuit, DACA recipients who do not have other options for affordable health coverage will be eligible for ACA coverage.
DACA recipients can receive financial assistance through a Marketplace plan, even if their income is below 100% of the federal poverty level. This includes Premium Tax Credits (PTC) and Cost Sharing Reductions (CSRs). Additionally, DACA recipients may be eligible for a "special enrollment period" in 2024, allowing them to start using health insurance on December 1, 2024, if they enroll by November 30, 2024.
It is important to note that the new federal rule does not change or expand eligibility for Federal Medicaid. However, several health coverage options, such as Moms & Babies, Medicaid Presumptive Eligibility (MPE), and the Family Planning Presumptive Eligibility (FPPE) Program, are available regardless of immigration status.
To apply for coverage, DACA recipients can utilize resources such as the federal government's call center, enrollment navigators, community-based organizations, and brokers or agents. These professionals can provide assistance and answer any questions about the enrollment process and health insurance options.
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DACA recipients are eligible for Health Insurance Marketplace coverage with financial assistance
On December 9, 2024, a federal judge issued an order blocking certain DACA recipients from accessing the Affordable Care Act in 19 states: Alabama, Arkansas, Florida, Idaho, Indiana, Iowa, Kansas, Kentucky, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, South Carolina, South Dakota, Tennessee, Texas, and Virginia. This ruling was the result of a lawsuit, KS v. US, challenging the Biden administration's Final Rule.
Despite this setback, DACA recipients in the remaining states will be eligible for Health Insurance Marketplace coverage with financial assistance, such as Premium Tax Credits (PTC) and Cost Sharing Reductions (CSRs). This means that DACA recipients who meet the other eligibility requirements can enroll in a Qualified Health Plan (QHP) through the Marketplace and receive financial help to pay for their premiums and out-of-pocket expenses. The income-based subsidies can lower the cost of premiums, deductibles, copays, and coinsurance.
The change in DACA recipients' eligibility for Health Insurance Marketplace coverage is the result of a final rule published by the U.S. Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (CMS). This rule modifies the definition of "lawfully present" for enrollment in a QHP through the Health Insurance Marketplace, effectively including DACA recipients in this category as of November 1, 2024.
DACA recipients interested in enrolling in Health Insurance Marketplace coverage can do so through various platforms, such as HealthCare.gov, state enrollment websites, or Covered California. They can also seek assistance from trained staffers at a federal call center, enrollment navigators, community-based organizations, or licensed brokers and agents.
It is important to note that the new federal rule does not change or expand eligibility for Federal Medicaid. However, DACA recipients may still have access to certain health coverage options, such as Moms & Babies, Medicaid Presumptive Eligibility (MPE), and the Family Planning Presumptive Eligibility (FPPE) Program, regardless of their immigration status.
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DACA recipients can enrol in private health insurance plans through the Affordable Care Act
Starting November 1, 2024, DACA recipients will be eligible to enrol in private health insurance plans through the health insurance marketplaces created by the Affordable Care Act (ACA). This means that, apart from the 19 states implicated in the KS v. U.S. lawsuit, DACA recipients who do not have other options for affordable health coverage can enrol in health insurance plans.
DACA recipients can enrol in private health insurance plans through HealthCare.gov or their state's health insurance marketplace. To enrol, you must file a federal tax return and not have comprehensive, affordable coverage from another source. Depending on your income, you may be able to get subsidies that make buying and using marketplace coverage more affordable.
There are two types of subsidies available through the health insurance marketplaces: the first is based on income, which determines your final subsidized premiums and reduced copayments, and the second are Cost Sharing Reductions (CSRs). CSRs help people with incomes up to 250% of FPL pay certain "out-of-pocket" costs of using healthcare, like deductibles and co-pays. To receive CSRs, you must select a silver-level plan.
DACA recipients with an SSN and/or an employment authorization card will be asked to enter that information in the application to verify their identity and status. Once you complete your application, your eligibility will be determined based on your income, family size, and other factors.
It is important to note that this new federal rule does not change or expand eligibility for Federal Medicaid. However, several health coverage options are available regardless of immigration status, and in some states, DACA recipients may be eligible for state-run health insurance programs.
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DACA recipients are eligible for a special enrollment period to select a health plan
The Biden-Harris Administration has finalized policies to increase access to health coverage for DACA recipients. The U.S. Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (CMS), has modified the definition of "lawfully present" to allow DACA recipients to be considered lawfully present for health insurance purposes. This change in definition makes it possible for DACA recipients to enroll in a Qualified Health Plan (QHP) through the Affordable Care Act (ACA) Health Insurance Marketplace.
Starting November 1, 2024, DACA recipients will be eligible to enroll in private health insurance plans through the ACA. This eligibility extends to plans like HealthCare.gov and Covered California, and DACA recipients can receive financial help if they qualify. Depending on their income, they may be able to get subsidies that make buying and using marketplace coverage more affordable.
DACA recipients who qualify to enroll in a Marketplace plan may also qualify for advance payments of the premium tax credit (APTC) and cost-sharing reductions (CSRs) to reduce the cost of their Marketplace coverage. Additionally, DACA recipients are eligible for a special enrollment period to select a health plan. This special enrollment period lasts 60 days, starting from November 1, 2024, and allows DACA recipients to have their Marketplace coverage begin as early as December 1, 2024, if they meet all other eligibility requirements.
It is important to note that the new federal rule does not change or expand eligibility for Federal Medicaid. However, several health coverage options are available regardless of immigration status, such as Moms & Babies, Medicaid Presumptive Eligibility (MPE), and the Family Planning Presumptive Eligibility (FPPE) Program.
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Frequently asked questions
Yes, DACA recipients are now eligible for ACA coverage. Starting on November 1, 2024, DACA recipients can enroll in private health insurance plans through the health insurance marketplaces created by the Affordable Care Act (ACA).
DACA recipients can visit Healthcare.gov or their state's enrollment website to enroll in a health insurance plan. They may also be able to get subsidized marketplace coverage depending on the type of coverage their employer offers and how much it costs as a percentage of their income.
DACA recipients who qualify to enroll in a Marketplace plan may also qualify for Advance Payments of the Premium Tax Credit (APTC) and Cost-Sharing Reductions (CSRs) to reduce the cost of their Marketplace coverage, depending on their income. Additionally, several health coverage options such as Moms & Babies, Medicaid Presumptive Eligibility (MPE), the Family Planning Presumptive Eligibility (FPPE) Program, and All Kids are available regardless of immigration status.
