Final rule expands healthcare access to DACA recipients
CMS estimates this rule could lead to 100,000 previously uninsured DACA recipients enrolling in health coverage.
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The Department of Health and Human Services and the Centers for Medicare and Medicaid Services has finalized a rule expanding healthcare access for Deferred Action for Childhood Arrivals (DACA) recipients, with the goal of ensuring they'll no longer be excluded from eligibility to enroll in a Qualified Health Plan through the Affordable Care Act Health Insurance Marketplace, or for coverage through a Basic Health Program.
CMS estimates this rule could lead to 100,000 previously uninsured DACA recipients enrolling in health coverage through Marketplaces or a BHP.
Those without health insurance are less likely to receive preventive or routine health screenings and may delay necessary medical care, incurring high costs and debts when they do seek care, according to CMS.
DACA recipients are currently three times more likely to be uninsured than the general U.S. population, the agency said. 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.
WHAT'S THE IMPACT?
Due to the rule, DACA recipients and other newly eligible individuals will qualify for a special enrollment period to select a health plan through the marketplace during the 60 days following the rule's November 1 effective date.
This timing also corresponds with the 2025 Open Enrollment Period, which CMS said will help ensure newly eligible individuals are able to seamlessly enroll in coverage.
Those who apply for coverage in November can have their marketplace coverage begin as early as December 1 if they meet all other eligibility requirements. DACA recipients and others who are eligible for a BHP can apply for and receive coverage as early as November 1.
CMS also made technical modifications to the definition of "lawfully present" used to determine eligibility for coverage through a marketplace or a BHP. This, the agency said, is to promote administrative efficiency, clarity and transparency.
All provisions of the final rule will be effective on November 1.
THE LARGER TREND
In 2012, President Obama and then Vice President Biden announced the Deferred Action for Childhood Arrivals (DACA) program to allow young people to live and work in the United States.
Legal challenges from GOP-led states have blocked the administration's attempts to provide Dreamers a pathway to citizenship. The DACA program was ruled unlawful in 2021.
The federal rule, announced Friday, means DACA recipients are no longer excluded from receiving coverage from a quality health plan, according to Health and Human Services Secretary Xavier Becerra.
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.
