On Friday May 03, 2023, the Centers for Medicare & Medicaid Services (CMS) published a final rule to modify the definition of “lawfully present” applicable to eligibility for enrollment in a Qualified Health Plan (QHP) through the Marketplace and a Basic Health Program (BHP) to no longer exclude Deferred Action for Childhood Arrivals (DACA) recipients from that definition, and, for such programs, treating DACA recipients the same as all other recipients of deferred action. Effective November 1, 2024, this rule allows DACA recipients who meet all other eligibility requirements to enroll in:
a QHP through the Marketplace with financial assistance such as Advance Payments of the Premium Tax Credit (APTC) and Cost Sharing Reductions (CSRs); or
a BHP.
These changes support the Affordable Care Act (ACA)’s goals of increasing access to health insurance and improving the health and well-being of people by providing access to affordable, quality health coverage for many uninsured DACA recipients. CMS estimates that this rule could lead to 100,000 previously uninsured DACA recipients newly enrolling in health coverage through a Marketplace plan or a BHP.
In addition, CMS made some technical modifications to the definition of “lawfully present” used to determine eligibility for these programs to create administrative efficiencies, streamline verification processes, and promote clarity and transparency. The final rule also updates the definition of “qualified noncitizen” for Medicaid and CHIP, which clarifies the categories of noncitizens that states must cover in these programs.
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