Biden administration to extend Affordable Care Act coverage to DACA recipients

The Affordable Care Act (ACA) marketplace may soon see a new population of adults enrolling: immigrants in the Deferred Action for Childhood Arrivals (DACA) program.

The Biden administration announced on Friday it would modify an ACA eligibility requirement to include DACA recipients. The Centers for Medicaid and Medicare Services (CMS) estimated it could add at least 100,000 in DACA to the marketplace, Neera Tanden, director of the US Domestic Policy Council, said in a press call.

Previously, people were only eligible for ACA coverage if they were US citizens, US nationals, or “lawfully present” immigrants. The Biden administration rule change would extend the definition of “lawfully present” to include those in the DACA program, allowing them to enroll in health plans, according to a fact sheet shared by US Health and Human Services (HHS).

These “Dreamers” would still have to meet other criteria to enroll, like falling under household income limits and not receiving coverage through an employer. But if they do, they could be eligible for a qualified health plan with financial assistance, like cost-sharing reductions, or a basic health plan, Tanden said.

The administration initially touted the rule change more than a year ago, and it was originally supposed to go into effect in November 2023. Instead, it will go into effect November 1, 2024, according to the HHS fact sheet.

“This final rule reflects the president’s belief that healthcare is a right, not a privilege, for all Americans—that it should extend to DACA recipients just like the rest of us,” Tanden said.

DACA recipients are currently 3x more likely to be uninsured than the general US population, Xavier Becerra, HHS secretary, said in the press call.

“DACA recipients are no longer excluded from receiving coverage from a quality health plan and financial assistance as well,” Becerra said. “Now they can access the Affordable Care Act Health Insurance Marketplace. Now they can access coverage to a basic health health care program. Dreamers are now treated the same as other immigrant individuals granted deferred action for purposes of eligibility for these programs.”

But, this change in definition for “lawfully present” won’t extend to policies with Medicaid or Children’s Health Insurance Program (CHIP) coverage, according to the fact sheet. This is because CMS is still considering some of the issues around the “interactions” with Medicaid programs, according to a senior administration official.

The addition of DACA adults will follow a record 21+ million people enrolling in the ACA marketplace as of this year, a growth partially due to states disenrolling people from Medicaid coverage as part of post-pandemic redeterminations, as Healthcare Brew previously reported.

“Like all our other Americans, President Biden wants to ensure that they get the healthcare they need and the peace of mind that comes with it,” Becerra said.