Health Center Regulatory Issues

Coverage Options in the Exchange for Lawfully Present Immigrants

By Heidi Emerson

As the March 31st  deadline for open enrollment in the Marketplace approaches,  it’s worth reviewing  the coverage options under the ACA for “lawfully present” immigrants who are in the income range for Medicaid coverage or exchange premium tax credits, and may be subject to the five-year waiting period for Medicaid or CHIP coverage. In July 2012, HHS defined “lawfully present” immigrants for the purposes of eligibility for the ACA’s high-risk insurance pools or the Pre-Existing Condition Insurance Plans (PCIP), and includes not only “qualified” immigrants, but other non-U.S. citizens who have permission to live and/or work in the U.S.[i]    The categories considered as “lawfully present” are described here. “Lawfully present” immigrants with incomes of less than 100 percent FPL, as well as those with incomes between 100-400% FPL , and who are not eligible for the Medicaid program, will be able to purchase coverage in the federal or state-run health insurance exchanges,[ii] and receive tax credits[iii].  The  Medicaid five-year waiting period for immigrant eligibility does not apply. A summary of coverage options are available here.

However, for Medicaid, “lawfully present” immigrants will continue to face the waiting period.  Medicaid and CHIP are available to eligible “qualified” immigrants who have resided in the US for five years or longer, and to others, such as refugees, who can obtain Medicaid or CHIP without a five-year waiting period. States have the option to eliminate the five-year wait for Medicaid or CHIP coverage for otherwise eligible children and pregnant women, but not for other adults. Coverage options for other categories of immigrants will continue to face eligibility restrictions for both Medicaid and the Exchanges leading to enrollment and access barriers as outlined in a Kaiser Commission report in March 2013 which can be accessed  here.  A new map by The National Immigration Law Center (NILC) highlighting current access to Medicaid and CHIP for immigrant children and pregnant women in all 50 States and the District Columbia is posted on their website. NILC also provides a list of  Medical Assistance Programs for Immigrants in Various States, including those funded solely by state dollars.

[i] 75 FR 45014 (July 30, 2010)

[ii] 26 C.F.R. § 1.36B-1(g); 77 FR 30377 (May 23, 2012),

[iii] 45 C.F.R. § 155.2; 77 FR 18310 (March 27, 2012)