[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 2149 Introduced in Senate (IS)]
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119th CONGRESS
1st Session
S. 2149
To expand access to health insurance coverage for immigrants and their
families by removing legal and policy barriers to health insurance
coverage, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 24, 2025
Mr. Booker (for himself, Mr. Heinrich, Mr. Padilla, Ms. Warren, Mrs.
Murray, Ms. Hirono, Mr. Sanders, Mr. Blumenthal, and Mr. Markey)
introduced the following bill; which was read twice and referred to the
Committee on Finance
_______________________________________________________________________
A BILL
To expand access to health insurance coverage for immigrants and their
families by removing legal and policy barriers to health insurance
coverage, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Health Equity and Access under the
Law for Immigrant Families Act of 2025''.
SEC. 2. PURPOSE.
It is the purpose of this Act to--
(1) ensure that all individuals who are lawfully present in
the United States are eligible for all Federally funded health
care programs;
(2) advance the ability of undocumented individuals to
obtain health insurance coverage through the health insurance
exchanges established under part II of the Patient Protection
and Affordable Care Act, Public Law 111-148;
(3) eliminate the authority for States to restrict Medicaid
eligibility for lawful permanent residents; and
(4) eliminate other barriers to accessing Medicaid, CHIP,
and other medical assistance.
SEC. 3. REMOVING BARRIERS TO HEALTH COVERAGE FOR LAWFULLY RESIDING
INDIVIDUALS.
(a) Medicaid.--Section 1903(v)(4) of the Social Security Act (42
U.S.C. 1396b(v)(4)) is amended--
(1) by amending subparagraph (A) to read as follows:
``(A) Notwithstanding sections 401(a), 402(b), 403,
and 421 of the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996, a State shall
provide medical assistance under this title, to
individuals who are lawfully residing in the United
States (including individuals described in paragraph
(1), battered individuals described in section 431(c)
of such Act, and individuals with an approved or
pending application for deferred action or other
Federally authorized presence), if they otherwise meet
the eligibility requirements for medical assistance
under the State plan approved under this title (other
than the requirement of the receipt of aid or
assistance under title IV, supplemental security income
benefits under title XVI, or a State supplementary
payment).'';
(2) by amending subparagraph (B) to read as follows:
``(B) No debt shall accrue under an affidavit of
support against any sponsor of an individual provided
medical assistance under subparagraph (A) on the basis
of provision of assistance to such individual and the
cost of such assistance shall not be considered as an
unreimbursed cost.''; and
(3) in subparagraph (C)--
(A) by striking ``an election by the State under
subparagraph (A)'' and inserting ``the application of
subparagraph (A)'';
(B) by inserting ``or be lawfully present'' after
``lawfully reside''; and
(C) by inserting ``or present'' after ``lawfully
residing'' each place it appears.
(b) CHIP.--Subparagraph (P) of section 2107(e)(1) of the Social
Security Act (42 U.S.C. 1397gg(e)(1)) is amended to read as follows:
``(P) Paragraph (4) of section 1903(v) (relating to
lawfully present individuals and undocumented
immigrants).''.
(c) Effective Date.--
(1) In general.--Except as provided in paragraph (2), the
amendments made by this section shall take effect on the date
of enactment of this Act and shall apply to services furnished
on or after the date that is 90 days after such date of
enactment.
(2) Exception if state legislation required.--In the case
of a State plan for medical assistance under title XIX, or a
State child health plan under title XXI, of the Social Security
Act which the Secretary of Health and Human Services determines
requires State legislation (other than legislation
appropriating funds) in order for the plan to meet the
additional requirements imposed by the amendments made by this
section, the respective State plan shall not be regarded as
failing to comply with the requirements of such title solely on
the basis of its failure to meet these additional requirements
before the first day of the first calendar quarter beginning
after the close of the first regular session of the State
legislature that begins after the date of enactment of this
Act. For purposes of the previous sentence, in the case of a
State that has a 2-year legislative session, each year of such
session shall be deemed to be a separate regular session of the
State legislature.
SEC. 4. CONSISTENCY IN HEALTH INSURANCE COVERAGE FOR INDIVIDUALS WITH
FEDERALLY AUTHORIZED PRESENCE, INCLUDING DEFERRED ACTION.
(a) In General.--For purposes of eligibility under any of the
provisions described in subsection (b), all individuals granted
Federally authorized presence in the United States shall be considered
to be lawfully present in the United States.
(b) Provisions Described.--The provisions described in this
subsection are the following:
(1) Exchange eligibility.--Section 1411 of the Patient
Protection and Affordable Care Act (42 U.S.C. 18031).
(2) Reduced cost-sharing eligibility.--Section 1402 of the
Patient Protection and Affordable Care Act (42 U.S.C. 18071).
(3) Premium subsidy eligibility.--Section 36B of the
Internal Revenue Code of 1986 (26 U.S.C. 36B).
(4) Medicaid and chip eligibility.--Titles XIX and XXI of
the Social Security Act, including under section 1903(v) of
such Act (42 U.S.C. 1396b(v)).
(c) Effective Date.--
(1) In general.--Subsection (a) shall take effect on the
date of enactment of this Act.
(2) Transition through special enrollment period.--In the
case of an individual described in subsection (a) who, before
the first day of the first annual open enrollment period under
subparagraph (B) of section 1311(c)(6) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18031(c)(6))
beginning after the date of enactment of this Act, is granted
Federally authorized presence in the United States and who, as
a result of such subsection, qualifies for a subsidy under a
provision described in paragraph (2) or (3) of subsection (b),
the Secretary of Health and Human Services shall establish a
special enrollment period under subparagraph (C) of such
section 1311(c)(6) during which such individual may enroll in
qualified health plans through Exchanges under title I of the
Patient Protection and Affordable Care Act and qualify for such
a subsidy. For such an individual who has been granted
Federally authorized presence in the United States as of the
date of enactment of this Act, such special enrollment period
shall begin not later than 90 days after such date of
enactment. Nothing in this paragraph shall be construed as
affecting the authority of the Secretary to establish
additional special enrollment periods under such subparagraph
(C).
SEC. 5. REMOVING CITIZENSHIP AND IMMIGRATION BARRIERS TO ACCESS TO
AFFORDABLE HEALTH CARE UNDER THE ACA.
(a) In General.--
(1) Premium tax credits.--Section 36B of the Internal
Revenue Code of 1986 is amended--
(A) in subsection (c)(1)(B)--
(i) by amending the heading to read as
follows: ``Special rule for certain individuals
ineligible for medicaid due to status''; and
(ii) by amending clause (ii) to read as
follows:
``(ii) the taxpayer is a noncitizen who is
not eligible for the Medicaid program under
title XIX of the Social Security Act by reason
of the individual's immigration status,''; and
(B) by striking subsection (e).
(2) Cost-sharing reductions.--Section 1402 of the Patient
Protection and Affordable Care Act (42 U.S.C. 18071) is amended
by striking subsection (e) and redesignating subsection (f) as
subsection (e).
(3) Basic health program eligibility.--Section
1331(e)(1)(B) of the Patient Protection and Affordable Care Act
(42 U.S.C. 18051(e)(1)(B)) is amended by striking ``lawfully
present in the United States,''.
(4) Restrictions on federal payments.--Section 1412 of the
Patient Protection and Affordable Care Act (42 U.S.C. 18082) is
amended by striking subsection (d) and redesignating subsection
(e) as subsection (d).
(5) Requirement to maintain minimum essential coverage.--
Subsection (d) of section 5000A of the Internal Revenue Code of
1986 is amended by striking paragraph (3) and by redesignating
paragraph (4) as paragraph (3).
(b) Conforming Amendments.--
(1) Establishment of program.--Section 1411(a) of the
Patient Protection and Affordable Care Act (42 U.S.C. 18081(a))
is amended by striking paragraph (1) and redesignating
paragraphs (2), (3), and (4) as paragraphs (1), (2), and (3),
respectively.
(2) Qualified individuals.--Section 1312(f) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18032(f)) is
amended--
(A) in the heading, by striking ``; Access Limited
to Citizens and Lawful Residents''; and
(B) by striking paragraph (3).
(c) Effective Date.--The amendments made by this section shall
apply to years, plan years, and taxable years, as applicable, beginning
after December 31, 2025.
SEC. 6. STATE OPTION TO EXPAND MEDICAID AND CHIP TO INDIVIDUALS WITHOUT
LAWFUL PRESENCE.
(a) Medicaid.--
(1) In general.--Section 1902(a)(10)(A)(ii) of the Social
Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended--
(A) in subclause (XXII), by striking ``or'' at the
end;
(B) in subclause (XXIII), by striking the semicolon
and inserting ``; or''; and
(C) by adding at the end the following new
subclause:
``(XXIV) who would be eligible
under the State plan (or waiver of such
plan) under this title if they were
citizens of the United States;''.
(2) Conforming amendment.--Section 1905(a) of the Social
Security Act (42 U.S.C. 1396d(a)) is amended, in the matter
preceding paragraph (1)--
(A) in the matter designated as clause (xvi), by
striking ``or'' at the end;
(B) in the matter designated as clause (xvii), by
adding ``or'' at the end; and
(C) by inserting after the matter designated as
clause (xvii) the following:
``(xviii) individuals described in section
1902(a)(10)(A)(ii)(XXIV),''.
(b) CHIP.--Title XXI of the Social Security Act (42 U.S.C. 1397aa
et seq.) is amended by inserting after section 2112 the following new
section:
``SEC. 2112A. STATE OPTION TO PROVIDE COVERAGE FOR INDIVIDUALS WITHOUT
LAWFUL PRESENCE.
``A State may elect through an amendment to its State child health
plan under section 2102 to treat an individual as a targeted low-income
child or a targeted low-income pregnant woman for purposes of this
title if such individual would otherwise be included as such a child or
such a pregnant woman (as applicable) under such plan if the individual
were a citizen of the United States.''.
(c) Nonapplication of Eligibility Prohibition.--Section 401(a) of
the Personal Responsibility and Work Opportunity Reconciliation Act of
1996 (42 U.S.C. 1611(a)) is amended by adding at the end the following
new sentence: ``The preceding sentence shall not apply with respect to
a noncitizen's eligibility under a State plan (or waiver of such plan)
under title XIX of the Social Security Act or under a State child
health plan (or waiver of such plan) under title XXI of such Act to the
extent that such State has elected to make such individual so eligible
pursuant to section 1902(a)(10)(A)(ii)(XXIV) or 2112A of such Act,
respectively.''.
SEC. 7. PRESERVING ACCESS TO COVERAGE.
(a) In General.--Nothing in this Act, including the amendments made
by this Act, shall prevent lawfully present noncitizens who are
ineligible for full benefits under the Medicaid program under title XIX
of the Social Security Act from securing a credit for which such
lawfully present noncitizens would be eligible under section
36B(c)(1)(B) of the Internal Revenue Code of 1986 and under the
Medicaid provisions for lawfully present noncitizens, as in effect on
the date prior to the date of enactment of this Act.
(b) Definition.--For purposes of subsection (a), the term ``full
benefits'' means, with respect to an individual and State, medical
assistance for all services covered under the State plan under title
XIX of the Social Security Act that is not less in amount, duration, or
scope, or is determined by the Secretary of Health and Human Services
to be substantially equivalent to the medical assistance available for
an individual described in section 1902(a)(10)(A)(i) of the Social
Security Act (42 U.S.C. 1396a(a)(10)(A)(i)).
SEC. 8. REMOVING BARRIERS TO HEALTH COVERAGE FOR LAWFULLY PRESENT
INDIVIDUALS IN MEDICARE.
(a) Part A.--Section 1818(a)(3) of the Social Security Act (42
U.S.C. 1395i-2(a)(3)) is amended by striking ``an alien'' and all that
follows through ``under this section'' and inserting ``an individual
who is lawfully present (as defined in section 8(c) of the `Health
Equity and Access under the Law for Immigrant Families Act of 2025') in
the United States, including an individual with an approved or pending
application for deferred action or other Federally authorized
presence''.
(b) Part B.--Section 1836(a)(2) of the Social Security Act (42
U.S.C. 1395o(a)(2)) is amended by striking ``an alien'' and all that
follows through ``under this part'' and inserting ``an individual who
is lawfully present (as defined in section 8(c) of the `Health Equity
and Access under the Law for Immigrant Families Act of 2025') in the
United States, including an individual with an approved or pending
application for deferred action or other Federally authorized
presence''.
(c) Lawfully Present Defined.--The term ``lawfully present'' shall
include, at a minimum, all immigration categories that are treated as
lawfully present for purposes of the title XIX program as amended by
section 3.
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