Undocumented Immigrants

via MNsure:

ST. PAUL, Minn.—The Minnesota Insulin Safety Net Program was created in 2020 to help Minnesotans who face difficulty affording their insulin. During the 2023 legislative session, the Minnesota Legislature made important changes to the program that will improve access to this life-saving drug for undocumented Minnesotans who are struggling to afford their insulin.

Starting August 1, 2023, Minnesotans can use an Individual Taxpayer Identification Number (ITIN) as an accepted form of identification for program eligibility. This change provides a pathway to access the program for those who do not have a valid Minnesota identification card, driver’s license or permit, or tribal-issued identification. For minors under the age of 18 who need help affording insulin, a parent or legal guardian can use an ITIN as an accepted form of identification.

Two weeks ago, the Associated Press reported that the Biden Administration planned on opening up eligibility for ACA exchange, Basic Health Program, Medicaid & CHIP coverage to hundreds of thousands of Americans who have Deferred Action of Childhood Arrivals status:

President Joe Biden is set to announce that his administration is expanding eligibility for Medicaid and the Affordable Care Act’s health insurance exchanges to hundreds of thousands of immigrants brought to the U.S. illegally as children, according to two U.S. officials briefed on the matter.

The action will allow participants in the Obama-era Deferred Action for Childhood Arrivals program, or DACA, to access government-funded health insurance programs. The officials spoke on the condition of anonymity to discuss the matter before the formal announcement on Thursday.

Last August, Ben D'Avanzo of the National Immigration Law Center wrote a guest post here at ACA Signups about the 23% of uninsured Americans who are immigrants, and the challenges in providing healthcare coverage for them. In it, he noted that:

...given the slow nature of congressional action, the Biden administration can take some important steps now. For example, HHS could make hundreds of thousands of DACA recipients eligible for ACA coverage through regulatory action. It could also build on its existing investment in outreach and assistance programs to fund more Navigators and other community organizations that are best suited for immigrant-focused enrollment work.

via the Washington Post:

...The proposal at issue would allow undocumented immigrants to buy health insurance through the state exchange, a policy change that state analysts predict would lead to coverage for about one-third of the state’s undocumented population, or 82,500 people. The move would add Maryland to a small number of states targeting the group in an effort to shore up gaps in health care access — a goal that has faced head winds in Congress.

Supporters say the proposal dovetails with Gov. Wes Moore’s goal of eliminating child poverty and would reduce overall premiums and care provided by hospitals free of charge to the uninsured. But instead of passing a bill that would open the insurance marketplace, which would require a federal waiver, lawmakers instead approved legislation that calls for the Maryland Health Department and the Maryland Health Benefit Exchange to study options for undocumented immigrants’ health care needs to guide their work moving forward.

via the California Dept. of Justice website:

Attorney General Bonta Announces $2.1 Million Settlement Against Companies Over Sham Health Insurance Plans

OAKLAND — California Attorney General Rob Bonta today announced a $2.1 million settlement against two companies, Shared Health Alliance, Inc. (SHA) and Alliance for Shared Health (ASH), to resolve allegations that they offered and deceptively advertised sham health insurance and violated insurance regulations that protect consumers. ASH, a nonprofit corporation that purported to be a healthcare sharing ministry (HCSM), created, operated, and sold unauthorized health insurance through its for-profit administrative vendor, SHA.

via Melanie Mason of the L.A. Times:

A new bill introduced in the California state Senate aims to lay the groundwork for a state universal healthcare system, proposing an incremental approach that departs from recent sweeping, and unsuccessful, efforts to reshape how Californians receive care.

Under the measure by state Sen. Scott Wiener (D-San Francisco), California would begin the process of seeking a waiver from the federal government to allow Medicaid and Medicare funds to be used for a first-in-the-nation single-payer healthcare system.

“In the wake of COVID-19’s devastation, and as costs for working people have skyrocketed, the need to provide affordable healthcare to all Californians has never been greater,” Wiener said in a statement. He touted his measure as making “tangible steps on a concrete timeline toward achieving universal and more affordable healthcare in California.”

Hawaii Senate Bill 842 was introduced in January by 10 Democratic state legislators.

I've grown to absolutely love the way Hawaii state legislation summarizes the situation being addressed by the bill in question; they don't hold any punches in explaining why the bill is necessary:

The legislature finds that obstacles to access to health care based solely on immigration status prevent many low-income immigrants and immigrants' families from obtaining affordable health care coverage through medicaid, the Children's Health Insurance Program (CHIP), and health insurance exchanges established under part II of the Patient Protection and Affordable Care Act.

As I noted last week, Washington State is the first in the nation to finally correct one of the dumbest provisions of the Affordable Care Act as it was originally passed:

(3) Access limited to lawful residents.--If an individual is not, or is not reasonably expected to be for the entire period for which enrollment is sought, a citizen or national of the United States or an alien lawfully present in the United States, the individual shall not be treated as a qualified individual and may not be covered under a qualified health plan in the individual market that is offered through an Exchange.

Again, this doesn't just mean that they can't get federal financial help; it means they can't enroll via ACA exchanges at all:

Undocumented immigrants aren’t eligible to buy Marketplace health coverage, or for premium tax credits and other savings on Marketplace plans. But they may apply for coverage on behalf of documented individuals.

Connecticut House Bill 6616 was introduced to the state House in February with a total of 13 cosponsors (all Democrats). Since then it's had a public hearing and has been reported favorably out of the legislative commissioners' office and to the House Appropriations Committee.

The bill seems to expand Medicaid and/or CHIP eligibility ("Husky A, B or D") to a significant number of undocumented children in the state, but it's rather densely worded, making it difficult for me to be certain just how far up the age range it applies. However, according to Louise Norris, it would extend it from the current 12-year old limit for undocumented children up to age 20 by January 2024 and age 25 by later that year, as long as their household income is still below the thresholds currently in place for those populations:

Section 17b-261 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2024):

I first wrote about this back in May 2022, but had lost track of the waivers' status since then. As I wrote at the time:

One of the most inane restrictions of the ACA in my view, as I noted in my "If I Ran the Zoo" wish list back in 2017, is that it doesn't allow undocumented immigrants to enroll in ACA marketplace health plans ("Qualified Health Plans" or QHPs).

I don't just mean that they aren't eligible for federal financial subsidies--that's a prohibition which I can at least understand, even if I don't agree with it. I mean that they aren't allowed to enroll in ACA exchange-based QHPs even at full price, as noted in Section 1312(f)(3):