Updated Apr 14, 2023 - Health

Biden admin proposes expanding health coverage to DACA

Illustration of a caduceus spearing a map of the United States.

Illustration: Aïda Amer/Axios

Undocumented immigrants who were brought to the U.S. as children could enroll in Medicaid, the Children's Health Insurance Program and Affordable Care marketplaces under a proposal the Biden administration submitted on Thursday.

Why it matters: The plan could trigger a fight with conservatives who've resisted expanding Medicaid and are sharply at odds with the administration over immigration policy.

The big picture: The proposal applies to individuals in the Deferred Action for Childhood Arrivals (DACA) program, which has been in place since 2012 despite litigation and Trump administration attempts cut the program.

  • The 5th Circuit Court of Appeals last October largely upheld a district court ruling that the program was unlawful, but kept it for existing DACA recipients who arrived by 2007, pending lower court to review of a Biden administration's DACA final rule.
  • The administration estimates about 34% of the nearly 580,000 recipients in DACA don’t have health coverage.
  • Others say the percentage without coverage is nearly half.

What they're saying: "We're not done fighting for their pathway to citizenship, but we're getting them the opportunities they deserve in the meantime," President Biden said on a video announcing the initiative.

Yes, but: The proposal could get ensnared in a dispute over the Trump administration’s 2019 public charge rule, which threatened to deny visas to individuals who sought government benefits like food stamps or Medicaid.

  • The Biden administration stopped enforcing it in March 2021, but misinformation and deportation fears kept some non-citizens from seeking emergency aid they were entitled to during the pandemic.
  • This included COVID-19 tests and treatment and federal nutrition programs.
  • Earlier this year, Texas filed a lawsuit challenging the reversal of public charge, signaling yet another legal battle ahead.

Catch up quick: The pandemic's impact on immigrants — especially those deemed essential workers — accelerated a push among states to extend Medicaid and CHIP benefits for prenatal care and postpartum coverage regardless of immigration status.

  • States have had the option to do this since 2002, but many deferred because of cost and opposition to expanding safety net programs, especially to undocumented people.
  • Some, like New York, have had to set up special dedicated state funds to cover the cost since federal money doesn’t pay for health benefits for those without legal status.
  • In Congress, Democrats like Sens. Cory Booker (N.J.) and Elizabeth Warren (Mass.) attempted to move legislation akin to what Biden is proposing.

By the numbers: As of Jan., 11 states plus the District of Columbia allow non-citizen children to enroll in Medicaid or CHIP, according to a tracker from the Kaiser Family Foundation.

  • Colorado plans to do so by 2025.
  • Others, like California and Illinois, have expanded state-funded coverage to some undocumented adults with low incomes.
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