In a significant move aimed at enhancing healthcare access for Deferred Action for Childhood Arrivals (DACA) recipients, the Biden-Harris Administration has finalized a rule that expands eligibility for health coverage under the Patient Protection and Affordable Care Act (PPACA) and Basic Health Program (BHP).
DACA is a program enacted in 2012 that provides relief from deportation and work authorization for immigrants brought to the United States as children. This policy shift, announced by the U.S. Department of Health and Human Services (HHS) through the Centers for Medicare & Medicaid Services (CMS), represents a step in the right direction toward ensuring equitable healthcare for residents in the United States.
Specifically, the ruling makes a minor but important change to the definition of “lawfully present,” which is a requirement for eligibility enrollment in a qualified health plan. The current definition of “lawfully present” does include certain immigration classifications, such as Green Card holders, Cuban and Haitian entrants, and so many other classifications; however, it specifically excludes DACA. With this modification, DACA recipients will no longer be excluded from that definition, making it possible to participate in the next enrollment period starting Nov. 1, 2024.
It is important to note that the change of definition for eligibility under “lawfully present” does not apply to Medicaid or the Children’s Health Insurance Program (CHIP) at this time. The current eligibility for Medicaid and CHIP allows states to include coverage for children and pregnant individuals who are lawfully residing in the United States, including those within their first five years of having certain legal status.
To fill the gap, the PPACA will allow noncitizens who are ineligible for Medicaid because of their immigration status to access financial assistance, such as the Premium Tax Credits and Cost Sharing Reductions through a Marketplace plan, even if their income is below 100 percent of the federal poverty level.
This measure is expected to extend health coverage to approximately 100,000 previously uninsured DACA recipients, addressing a pressing need within the community. The news briefing on this change from CMS stresses the belief that healthcare coverage is a right, not a privilege.
CMS expressed a commitment to providing comprehensive education and technical assistance to support the implementation of this rule, ensuring that immigrants and other communities receive the necessary guidance to navigate the healthcare enrollment process effectively.
Healthcare has been transitioning toward a more digital, interconnected ecosystem for many years, but the pace and magnitude of current changes represent a fundamental shift.
H.R. 1 doesn’t directly rewrite ICD-10 or CPT, but it does change the environment in which you’re coding. The impact is mostly indirect – through
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