New CMS Rule Increases Access to Health Insurance for DACA Recipients

The Centers for Medicare & Medicaid Services (CMS) announced a final rule that will increase access to affordable health care options for recipients of the Deferred Action for Childhood Arrivals (DACA) program.

In the new rule, CMS has modified the “lawfully present” definition used to determine eligibility for health plans in the marketplace.

The new final rule expanding health insurance eligibility for DACA recipients will be effective November 1, 2024. It will allow DACA recipients to enroll in marketplace coverage during the 2025 Open Enrollment Period (OEP) or a Special Enrollment Period (SEP).

What Is DACA?

The DACA program was created under the Obama administration in 2012 as a way for undocumented immigrants who arrived in the United States as children to avoid deportation and gain access to select government programs. He created this program after the Development, Relief and Education for Alien Minors (DREAM) Act did not pass in Congress to safeguard children who did not make the choice to immigrate to the U.S. legally.

The young people impacted by DACA and the DREAM Act are often referred to as ‘Dreamers.’ Individuals who are eligible for DACA:

  • Were born after June 16, 1981
  • Entered the United States unlawfully before their 16th birthday
  • Have lived in the United States since June 15, 2007
  • Were physically present in America on June 15, 2012, and at the time for making their request for deferred action
  • Have no lawful status
  • Have completed high school or a GED program, were honorably discharged from the armed forces, or are enrolled in school
  • Have not been convicted of a felony or misdemeanor and do not pose a threat to national security

Within the DACA program, there isn’t a path to citizenship, and DACA status is not the same as a green card. DACA recipients have a Social Security number, can apply for a work permit, and a driver’s license. They can renew their status every two years and continue receiving benefits while not worrying about deportation.

There are 530,110 Dreamers as of December 2023, according to Migration Policy Institute. However, more than 1,160,000 people are eligible for DACA.

DACA recipients are protected against incurring an unlawful presence status, which can allow them to access other paths of legal immigration and can allow them to obtain health care services and education in the U.S.

New Modified Definition of Lawfully Present Status

The changes to the definition of lawfully present status will allow DACA recipients to enroll in a qualified health plan (QHP) through the marketplace or a Basic Health Program (BHP). Previously, Dreamers were able to enroll in an employer’s health insurance plan but were not eligible for the marketplace, Medicaid, or BHPs. DACA recipients will continue to be ineligible for Medicaid.

The lawfully present status will now allow DACA recipients to enroll in a qualified health plan through the marketplace or a Basic Health Program.

With the new definition of lawfully present and eligibility for marketplace coverage, DACA recipients will also be eligible for cost-sharing reductions to reduce health care spending.

CMS is making changes to ensure that eligibility is determined consistently and accurately. They estimate that 100,000 previously uninsured DACA recipients will be able to enroll in health coverage through the marketplace.

When Can DACA Recipients Enroll in Marketplace Coverage?

DACA recipients who meet all other eligibility requirements for marketplace coverage will be able to enroll in a plan during the OEP, which starts November 1, or during an SEP that begins the same day and lasts for 60 days. Individuals who apply for coverage in November via the SEP will have access to coverage as soon as December 1, 2024.

It’s important that agents are aware of individuals who are now eligible for a marketplace plan and reach out to them before the OEP. We encourage you to educate your community about the new opportunities for health insurance.

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The new rule that expanded health insurance eligibility for DACA recipients will allow more individuals to access affordable health care and enroll in marketplace coverage this year and beyond. This means there’s also a larger audience for agents to help sign up for insurance!

To learn more about the CMS final rule that modifies lawfully present status, you can read the CMS fact sheet or read the full final rule.

Ritter is dedicated to staying on top of the most recent changes in the marketplace beyond. Become a Ritter agent today so you don’t miss an update.

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