Health Reform WK-EDGE California to request waiver allowing undocumented immigrants to enroll through the exchange
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Monday, June 20, 2016

California to request waiver allowing undocumented immigrants to enroll through the exchange

By Kathryn S. Beard, J.D.

Covered California, the state health insurance exchange, will apply to HHS for a section 1332 waiver that would allow otherwise eligible individuals who are unable to obtain health insurance by reason of immigration status to purchase coverage though the exchange. On June 10, 2016, Governor Jerry Brown (D) signed S.B. 10 into law. The requirement to offer qualified health plans to undocumented immigrants would become operative on January 1, 2018, for coverage effective beginning January 1, 2019. The law contains provisions that will require an applicant’s immigration status information to be used only to the extent necessary to authenticate identity and determine eligibility, and prevents the disclosure of such information for any other purpose.

Section 1411 of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) limits participation in the health insurance marketplace to citizens, nationals, and lawful permanent residents of the United States, thereby excluding undocumented aliens from participation. California has approximately 2.67 undocumented immigrants living in the state, most of whom are unable to obtain health insurance coverage through an employer or otherwise. State Senator Ricardo Lara (D-Bell Gardens) has introduced multiple unsuccessful bills to extend coverage to Californians without regard to immigration status (see California bill proposes expansion of health care coverage to undocumented immigrants, February 19, 2014; Bill to expand Medi-Cal to undocumented immigrants suspended, May 13, 2015).

Lara’s latest bill succeeded, however, where the previous attempts had failed. It uses section 1332 of the ACA, which allows for state innovation waivers to make changes to states’ implementation of the law, provided that coverage remains at least as comprehensive, affordable, and accessible as that provided for by the ACA (see Could Covered California cover the undocumented?, November 18, 2015). The new law, which received the support of the Covered California Board (see Covered California board supports innovation waiver, health insurance for the undocumented, April 13, 2016), requires the exchange to apply for such a waiver. If approved, the waiver would cover up to 390,000 Californians, according to the Los Angeles Times. The law only extends eligibility to those undocumented immigrants who are excluded solely on the basis of immigration status. It forbids undocumented immigrants from receiving federal advanced premium tax credits, federal cost-sharing reductions, or any other federal assistance for the payment of premiums or cost sharing for a California qualified health plan, in accordance with the ACA’s requirement that section 1332 waivers do not increase the federal deficit.

Legislation: StateLegislationNews NewsFeed AccessNews AgencyNews CostSharingNews HealthInsuranceExchangeNews PremiumTaxNews

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