What do Immigrant Families Need to Know About the Marketplace?

When the Affordable Care Act takes effect January 1, many – but not all – immigrant groups will have expanded access to insurance coverage. A new fact sheet from the Centers for Medicare and Medicaid Services (CMS) details what immigrant families, and their healthcare providers, need to know to enroll in new coverage.

More than half of non-U.S. citizen adults are uninsured, compared to 17 percent of adult citizens. Non-citizen adults are also less likely to have insurance through their employer, despite having similar employment rates to citizens. Likewise, immigrant children have much higher uninsured rates compared to children who are citizens. Lawfully present immigrants must wait five years in most states before becoming eligible for Medicaid. However, 22 states allow immigrant children with fewer than five years’ residency to enroll in Medicaid, and 18 states allow the same for pregnant immigrant women.

Options available to legal immigrants under the ACA depend on the number of years they have lived in the United States.

  • Naturalized citizens and legal immigrants who have lived in the U.S. for more than five years will have the same coverage opportunities as other Americans. They may purchase insurance in the health insurance marketplaces, and those under 400 percent of the poverty level are eligible for tax credits or subsidies to offset the cost. They may also enroll in Medicaid if they meet their state’s eligibility criteria.
  • Legal immigrants who have resided in the U.S. for five years or less will be able to purchase insurance in the marketplaces and will be eligible for tax credits/subsidies. Generally, they will not be eligible to enroll in Medicaid until the end of the five-year waiting period. However, the ACA’s Maintenance of Effort (MOE) provisions require that states maintain current eligibility standards for children through Sept. 30, 2019. This means that the 22 states that opted to cover immigrant children with less than five years’ residency must continue to do so post-ACA.

Population of focus: Immigrants, refugees, asylees

Links to resource:

Date: 2013

Organization: Centers for Medicare and Medicaid Services