New Regulations Extend Health Coverage to Deferred Action for Childhood Arrivals (DACA) Recipients

On May 3, 2024, the Biden Administration published new regulations that will extend eligibility for Marketplace coverage to Deferred Action for Childhood Arrivals (DACA) recipients. Under these regulations, the definition of lawfully present will newly include DACA recipients for the purposes of eligibility to purchase coverage through the Affordable Care Act (ACA) Marketplaces and to receive tax credits to help pay for premiums, or to enroll in Basic Health Program (BHP) coverage in states with those programs. The regulations will become effective November 1, 2024, facilitating enrollment during the 2025 Open Enrollment Period. The rule did not finalize a corresponding proposed change to the definition of lawfully present for Medicaid and the Children’s Health Insurance Program (CHIP), citing significant administrative burdens currently facing state Medicaid and CHIP agencies due to the Medicaid unwinding and other recent statutory eligibility changes. However, the Administration notes that most DACA recipients who may have been eligible for Medicaid and CHIP coverage under the proposed rule will be eligible for Marketplace coverage with subsidies or for BHP coverage.

The Administration estimates that 100,000 uninsured DACA recipients will receive coverage under the rule. Prior to these new regulations, DACA recipients were excluded from all federally funded health coverage options, leaving them with the same limited coverage options as undocumented immigrants generally, resulting in high uninsured rates. This new coverage will likely result in improved access to care and financial security for DACA recipients and their families, which could ultimately improve health outcomes. In addition, the Administration notes that enrollment of DACA recipients in Marketplace coverage could improve risk pools since they tend to generally be young and healthy, which may lead to some cost savings (See Box 1). Most of the costs associated with the rule are related to changes to application and eligibility systems and processes.

Box 1: Who Are DACA Recipients?

As of December 31, 2023, there were roughly 530,000 active DACA recipients in the U.S. from close to 200 different countries of birth. Over one in four (28%) active DACA recipients reside in California, with another 17% living in Texas, 5% in Illinois, 4% in New York, 4% in Florida, and the remaining 42% distributed in other states across the country. DACA recipients are young, with the majority under age 36, and over half are female. Seven in ten DACA recipients are single, while nearly three in ten are married.

While the new regulations will likely improve health care access for DACA recipients, the future of the program remains uncertain due to ongoing litigation and the 2024 election. DACA was originally established via executive action in June 2012 to protect certain undocumented immigrants who were brought to the U.S. as children from removal proceedings and receive authorization to work for renewable two-year periods. To be eligible, individuals must have arrived in the U.S. prior to turning 16 and before June 15, 2007; be under the age of 31 as of June 15, 2012 (i.e., under age 43 as of 2024); be currently enrolled in school, have completed high school or its equivalent or be a veteran; and have no lawful status as of June 15, 2012. Subject to ongoing litigation and court rulings, current DACA approvals and work authorizations remain in effect, and the Department of Homeland Security (DHS) will continue to process DACA renewal requests and related requests for employment authorization. It is also accepting initial DACA and employment authorization requests, however, it cannot process initial requests under the current court orders, so these requests remain on hold. The number of people who could receive DACA is decreasing over time given its eligibility requirements and current limits on new enrollment. The American Dream and Promise (DREAM) Act of 2023 would provide a pathway to lawful permanent resident status and eventually citizenship for undocumented immigrants who were brought to the U.S. as children and who meet certain requirements. Different versions of this Act have been proposed in the U.S. Congress since 2001, but have never been passed, and there does not appear to be a current pathway to passage for such legislation. Former President Trump tried to end DACA during his administration, but was blocked by the Supreme Court. His campaign has said he will try again to eliminate DACA protections if elected.

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