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Coverage for Immigrants and the Affordable Care Act

The Affordable Care Act, commonly referred to as “Obamacare” or the “ACA,” is a comprehensive health care reform Act that was passed in March 2010. The intent of the Act was to make quality and affordable health care available to the masses, keep insurance premiums down, protect individuals with pre-existing conditions, and to expand Medicaid.

One of the most controversial sections of the 2010 Act was the individual mandate, which prescribed that all individuals must carry health insurance or face a tax penalty. This section of the Act is no longer in effect and only applies to tax year 2018 and before. Starting with tax year 2019, the federal government no longer assess tax penalties for failure to maintain health insurance.

Health Insurance is typically obtained in one of two ways, (1) through one’s employer, or (2) through private health insurance.

The Affordable Care Act set up a ‘Marketplace’ in which individuals could ‘shop’ for health insurance plans. The ACA set minimum levels of coverage for all private and employer-sponsored insurance plans.

    Some of the Rights and Benefits provided by the ACA are:

    • All plans must cover people with pre-existing health conditions, including pregnant women;
    • Free preventative care;
    • Plans must provide mental health services;
    • Terminates lifetime limits;
    • Insurance companies may not cancel insurance simply because someone becomes ill;
    • Provides breastfeeding equipment;
    • Provides birth control counseling;
    • Individuals may choose a plan from the Marketplace rather than an employer-sponsored plan.

    Who is Covered By the Affordable Care Act, and to What Extent

    Naturalized Citizens: Same access and coverage as U.S. born citizens.

    Lawfully Present Immigrants:

    • May enroll in a plan from the Marketplace (with no waiting period).
    • Eligible for premium tax credits (with no waiting period).
    • Five year waiting period for Medicaid;
    • Some states allow lawfully resident children and pregnant women to enroll in Medicaid and CHIP (Children’s Health Insurance Program) without a waiting period;
    • Deferred Action for Childhood Arrivals (DACA) recipients are not eligible for Medicaid, ACA, or CHIP benefits.

    Undocumented Immigrants:

    • Ineligible to purchase private health insurance on the Marketplace;
    • Not eligible for premium tax credits;
    • Eligible for emergency care;
    • Eligible for Emergency Medicaid, based on income;
    • May avail of non-emergency services at community health centers.

    Note: Undocumented individuals may use the Marketplace and may apply for insurance or Medicaid on behalf of a lawfully resident child or other family members.

    Who May Use the Marketplace?

    The following groups of people may apply for a health insurance plan from the Marketplace:

    • Lawful Permanent Residents;
    • Asylees & Refugees;
    • Parolees;
    • VAWA applicants;
    • Victims of Trafficking;
    • Those granted Withholding of Removal;
    • Those granted protection under the Convention Against Torture;
    • Individuals in valid non-immigrant status (H, F, U, T, and other visa statuses);
    • Temporary Protected Status (TPS);
    • Deferred Enforced Departures (DED);
    • Deferred Action (but not Deferred Action for Childhood Arrivals);

    The following people, who have employment authorization, may apply for a health insurance plan from the Marketplace:

    • Registry Applicants;
    • Those with Orders of Supervision;
    • Applicants for Cancellation of Removal
    • Legalization.

    Verification Requirements

    • Lawful status must be verified for all persons enrolling in:
      • Private health insurance from the Marketplace;
      • Premium tax credits;
      • Medicaid; and
      • CHIP
    • Status is verified by either the Social Security Administration or USCIS.
    • Only those applying for benefits are required to provide their social security number and proof of status.
    • The system may require verification of household income by non-applicants.
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