Creating A Pathway To Affordable Health Insurance For Dreamers

On April 26, the Biden administration proposed rules to address a longstanding problem: "Dreamers," meaning young people who were brought to the United States as children and are now protected from deportation under the Deferred Action for Childhood Arrivals (DACA ). ) — do not have access to affordable health insurance unless it is provided by their employers. The rule would recognize DACA recipients as legal in the United States, allowing Dreamers, like other legal residents of the United States, to access marketplace coverage and, in some cases, Medicaid and CHIP. The deadline for comments is June 23.

Under the proposal, the administration would use the regulatory authority granted to the Secretary of the Department of Health and Human Services (HHS) under the Affordable Care Act (ACA) to expand the definition of a legal resident of the United States to include DACA recipients . . If finalized, the rule would immediately expand access to marketplace coverage, as well as premium care and cost-sharing subsidies for Dreamers. The proposal also applies an expanded definition of legal residency to Basic Health Care (BHP) programs currently offered in New York and Minnesota to low-income residents who would otherwise be able to participate in marketplace plans. . (Oregon is proposing to become the third state to offer BHP.)

The final rule will take effect in November 2023, when Dreamers will be able to take advantage of the open market enrollment period in 2024, in addition to the special enrollment period that applies to all individuals who requalify for marketplace plans. Additional outreach and support services will be available to help Dreamers navigate membership and possibly their first experiences.

The proposal also implements a broader definition of legal residence in the United States for Medicaid and the Children's Health Insurance Program (CHIP). Generally, Medicaid and CHIP applicants with newly acquired legal status in the United States must wait five years to enroll in these programs. But in states that took advantage of the flexibility rule that was part of the CHIP Reauthorization Act of 2009 (CHIPRA), coverage for pregnant women and children can begin immediately. The five-year Medicaid waiting period will apply to Dreamers (pregnant women and children) in states that do not elect CHIPRA and those applying for other Medicaid courses (such as the ACA extension for adults). Marketplace benefits will be available to newly approved Dreamers without a waiting period if they cannot qualify for Medicaid because of the waiting period.

Presentation is of great importance. Of the approximately 589,000 active DACA recipients in 2022, the administration estimates that more than one-third (34%) of recipients are uninsured. In addition, the proposal encourages Dreamers to take advantage of new coverage options, and about 200,000 Dreamers are expected to apply each year. Although the Medicaid and CHIP waiting periods have already ended, the changes are expected to have a significant impact on the 35 states and the District of Columbia that have enacted CHIPRA's ability to waive the waiting period for pregnant women and children.

Official projections say that 130,000 DACA recipients will be covered by all eligible insurance programs: marketplace plans, BHP plans, Medicaid and CHIP. Marketplace plans will account for the majority of enrollments at 119,000 new enrollments. The number of Medicaid enrollees will increase by 13,000 annually in 2024, then decline as the Little Dreamers age, falling to 6,000 by 2028. The rest will be mostly women.

Why did it take more than a decade to bring ACA's insurance coverage policies into compliance with DACA? Despite the Trump administration's attempt to end DACA and a number of states continuing to challenge DACA's existence, DACA has become a staple of legal immigration in the United States. Logically, access to ACA coverage should have followed DACA since this new legal status was first recognized in 2012. Because it did not, tens of thousands of children and youth remained uninsured for more than a decade .

By removing this barrier to marketplace benefits, Medicaid and CHIP, this proposal is a game changer. HHS is basing this major policy change to align DACA's status with other legal immigration classes on new evidence about the rates of uninsured Dreamers and the absence of any law preventing these regulatory changes. In doing so, the proposal removes a longstanding barrier to health equity.

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