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HHS DACA Comment Letter

The Honorable Xavier Becerra
Secretary of U.S. Department of Health & Human Services
200 Independence Ave SW
Washington, DC 20201

The Honorable Chiquita Brooks-LaSure
Centers for Medicaid & Medicare Services
U.S. Department of Health & Human Services
7500 Security Boulevard
Baltimore, Maryland, 21244

Re: CMS–9894–P: Clarifying Eligibility for a Qualified Health Plan Through an Exchange, Advance Payments of the Premium Tax Credit, Cost-Sharing Reductions, a Basic Health Program, and for Some Medicaid and Children’s Health Insurance Programs

Dear Secretary Becerra and Administrator Brooks-LaSure:  

Thank you for the opportunity to submit comments on the proposed rule, Clarifying Eligibility for a Qualified Health Plan Through an Exchange, Advance Payments of the Premium Tax Credit, Cost-Sharing Reductions, a Basic Health Program, and for Some Medicaid and Children’s Health Insurance Programs, which would extend access to Health Insurance Marketplace (marketplace) eligibility and financial assistance, as well as eligibility for Medicaid and Children’s Health Insurance Program health coverage to migrants with Deferred Action for Childhood Arrivals (DACA) status. As an organization focused on the health of young adults ages 18-34, we write in strong support of this proposed rule and encourage its immediate application and enforcement. 

Due to the use of the current definition of “lawfully present,” young immigrants across the country are denied access to quality, affordable health coverage, and by extension, many lack needed access to health care. While DACA status provides recipients with a work permit that in some cases leads to employer-sponsored health insurance, 129,000 DACA recipients remain completely uninsured. As we have seen throughout the Covid-19 pandemic, communities in the United States are only as healthy as their most vulnerable members. Access to health coverage provides young people the opportunity to manage their chronic conditions, receive adequate follow-up care after emergencies, and access to mental health services, while increasing the likelihood of financial stability. At a time when 50% of young adults are living with chronic conditions, and a third are suffering from mental health issues, it is essential to expand affordable access to health care for DACA recipients, of which a majority are under the age of 36 and actively contribute to our workforce across all industries. 

This proposed rule will provide DACA recipients new, affordable pathways to enroll in health insurance coverage, and thus the means by which to take advantage of critical services such as mental health, reproductive, and emergency care. We at Young Invincibles believe that health care is a human right and that this proposal is yet another important step to strengthening a key pillar of the Patient Protection and Affordable Care Act: ensuring more people, especially those members of vulnerable communities, are able to access quality health coverage and care. 

“I was two and half when I was brought to this country and have called Denver home for 27 years. I’m a first-generation high school graduate, college graduate, and postgraduate. I’ve held DACA since 2012 and I am thankful for the opportunities that come with this program. However, the barriers of affording health insurance still linger on. With DACA I have been able to obtain health insurance through my employer. But that doesn’t mean I can afford it, I have health issues that need attention, had many tests and been on different medications. The coverage of my insurance isn’t the best, so I’ve had to get on payment plans just to avoid my medical bills going to collections. I still have health issues that need more attention, but to avoid paying high out of pocket services, I avoid going to the doctor. As a DACA recipient I am not able to obtain state assistance of any kind and that includes affordable health insurance. If there was access to more affordable health insurance for DACA recipients I would not have issues going to the doctor.”

José, Colorado

As proposed, this rule is expected to take effect by November 1, 2023, in time for the start of the 11th Open Enrollment Period (OE11). It is essential that young DACA recipients be provided the opportunity to enroll in marketplace coverage during this predominantly singular window of time. To make this possible, we recommend an extensive outreach campaign to educate about this policy change and raise awareness about the new opportunities to access coverage. While the administration should take the lead, it should also consider leveraging the extensive network of community based organizations (CBOs), Navigators, and Certified Application Counselors (assisters) who, over the past 11 years, have become the trusted messengers in their communities.

Young Invincibles, and our National Get Covered Coalition (GCC) network of advocacy and assister organizations across the country, are dedicated to ensuring that communities facing additional barriers to health coverage are able to take advantage of every opportunity to access quality health insurance. For years, we have adjusted our health literacy trainings to the public to account for mixed-status immigrant families and DACA recipients who are ineligible for public health assistance. While this proposal will not encompass everyone, we look forward to ensuring   a seamless integration of outreach, enrollment, and education for DACA recipients into our work. For this to be successful, assisters and CBOs must have adequate training prior to the start of OE11. We expect that the Centers for Medicare and Medicaid Services (CMS) will have updated the Marketplace Learning Management System certification training for the 2024 plan year in time for assisters to become fully prepared to incorporate these changes in their outreach and enrollment work. 

“As a service provider to immigrant and refugee communities, including uninsured and underinsured populations, ACCESS welcomes the Biden administration’s proposed rule change to extend marketplace and Medicaid coverage to immigrants with DACA status. ACCESS also provides its client-base with education regarding the healthcare services for which they are eligible, which is a particular issue for individuals with DACA status, over half of whom are unaware of their affordable care options. The proposed rule change would directly address the social and systemic factors that contribute to poor health outcomes for immigrant communities across the country.”

Adam Beddawi
Policy Manager
ACCESS, Michigan

Thank you again for the opportunity to share our support for this proposed rule. We ask that you give all due consideration to the health needs of our DACA community members and encourage a swift implementation. 

Kristin McGuire
Executive Director
Young Invincibles 

Martha Sanchez
Director of Health Policy & Advocacy
Young Invincibles 

Certified Assisters, Navigators, and Advocacy Organization Signatories: 

ACA Consumer Advocacy
Civic Heart Community Services (Formerly Change Happens)
Covering New Hampshire, a project of Granite State Progress
Enlace Chicago
Every Texan
Eugenia DeLeon
FamilyCare Health Centers
Florida Covering Kids & Families
Foundation Communities
Guerrero Student Center
Missouri Connections for Health
Monica Vega
Ohio Association of Foodbanks
Palmetto Project, Inc.
PrimeCare Community Health
Tennessee Justice Center
University of Arizona, Center for Rural Health
582 Young Adults & Advocates: 

Dawn Albanese
Samantha Alcalá
Jessica Almendarez
Jl Angell
Heidi Appel
Patricia Auer
Aram Azadpour
Alex B
E.D. Barber
Jacqueline Bastard
Ann Bein
Jennifer Blakley
Karen Boehler
Kathy Bradley
Alberto Brambila
Jordan Briskin
Sean Brown
Tim Carrigan
Theresa Chapa
Alice Ciuffo
Howard Cohen
Ginger Comstock
Marilee Corey
Nancy Damato
Rainbow Di Benedetto
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Wilson Douglas
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Peggy Erickson
June Esposito
Victoria Everich
Ashley Farreny
Brenda Faust
Ed Fiedler
Veda Fish
Esther Friedman
John Friestad
Helen Gilchrist
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Robert Glass
Monica Gonzalez
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Aaron H
Robin Harper
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A Maguire
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Carol Nelson
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