Health Equity and Access under the Law for Immigrant Families Act of 2025
Health Equity and Access under the Law for Immigrant Families Act of 2025 seeks to greatly expand health coverage options for immigrants and their families by broadening who is eligible for federally funded health programs and ACA subsidies. The bill would treat more categories of noncitizens as “lawfully present,” remove several immigration-based barriers to Medicaid, CHIP, the ACA exchanges, and Medicare, and give states new authority to cover individuals without lawful presence. It also creates a pathway for undocumented individuals to access ACA subsidies and reduces or reshapes the penalties and barriers tied to immigration status in the ACA system. Overall, the measure aims to increase enrollment across Medicaid, CHIP, the ACA marketplaces, and Medicare for a broader set of immigrant populations, while limiting certain financial obligations tied to sponsors and refining enrollment timelines. The bill would take effect in stages, generally applying upon enactment with a 90-day implementation window for many provisions, and offering transitional enrollment opportunities for those who gain federally authorized presence after enactment. It also preserves existing benefit levels for many current beneficiaries and gives states new options to expand coverage to people without lawful presence, subject to state decisions. If enacted, the legislation could significantly expand health coverage among immigrant communities and alter the funding and eligibility landscape of Medicaid, CHIP, ACA subsidies, and Medicare.
Key Points
- 1Expands eligibility for federally funded health programs to include more individuals who are lawfully present, and extends consistency across ACA exchanges, premium subsidies, and Medicaid/CHIP for those with Federally authorized presence (including deferred action). It also clarifies that “lawfully present” includes categories treated as such under the amended Title XIX rules.
- 2Removes barriers related to immigration status that currently limit access to premium tax credits, cost-sharing reductions, and other ACA affordability programs; creates a transition pathway for those with immigration status to receive subsidies and participate in exchanges, and broadens Basic Health Program eligibility.
- 3Medicaid provisions: allows states to provide medical assistance to lawfully residing individuals who meet eligibility criteria, eliminates sponsor-debt liability tied to Medicaid, and removes certain restrictions linked to sponsorship, with a 90-day implementation window after enactment (and a state-legislation exception pathway).
- 4State option to expand coverage for people without lawful presence: states may amend their Medicaid and CHIP programs to cover individuals who would be eligible if they were U.S. citizens, and CHIP expands to cover noncitizens under a new 2112A provision; federal law is adjusted to permit this expansion where states choose to implement it.
- 5Medicare coverage changes: redefines “lawfully present” for Part A and Part B to include individuals with Federally authorized presence (including pending applications) and ensures consistency with the broader immigration-related eligibility framework.