Maryland House of Delegates approves bill to expand healthcare access for undocumented immigrants


James Sklar


On March 15th, Maryland’s House of Delegates voted 100-38 to pass House Bill 588, the Access to Care Act. The act requires the Maryland Health Benefit Exchange Fund to fund the establishment and operation of the Qualified Resident Enrollment Program, which would allow undocumented residents access to the state health insurance marketplace.


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“We made a commitment in the state, through various programs, to try to make sure every single person who lives in Maryland has healthcare,” Del. Bonnie Cullison (D – Montgomery) said in a previous committee hearing. “We believe, as a state, we shall enter policy, over and over again, that is an important human right, and that we can provide it to all of our residents. This bill is just the next step to get us closer to that goal.

The bill from my perspective, values and respects every Marylander who is seeking equity in healthcare. We have been committed to equity my entire tenure in this body. We made a promise to our residents. This bill takes it a step further.”

The Qualified Resident Enrollment Program would allow qualified residents to obtain coverage through Maryland’s Health Benefit Exchange, which administers Maryland Health Connection, the state’s health insurance marketplace.

Qualified residents include minors, individuals residing in the state, individuals who are not incarcerated, individuals who are not eligible for federal health programs, and individuals for whom immigration status is not a factor.

“Here in the state of Maryland, it is estimated that we have 275,000 residents who are undocumented, and about half of them do not have health insurance.” Sen. Clarence Lam (D – Anne Arundel) said in a previous committee hearing.

The new program funds would be offset by pass-through funds received from the federal government.  

The bill is estimated to not incur a cost for the 2024 fiscal year because it requires CMS approval of a waiver that can be issued using an existing budget resource. However, after federal pass-through funds are granted through the waiver, this new program is estimated to cost the state $90.3 million in 2025 and increase to $176.2 million by 2028.

It is estimated that 29,413 individuals will enroll in this new program in 2025 and that this will increase to 51,380 by 2028.

Currently, undocumented residents may qualify for emergency medical services. In a Senate Finance Committee meeting, Lam, who introduced the Access to Care Act in the Senate, stated that emergency medical services for undocumented residents cost the state about $118 million in 2020. He said this act would expand access to affordable healthcare, thereby reducing premiums across the board and saving money for the state in the long run.

Before the implementation of this new program, Maryland requires approval from the US Secretaries of Health and Human Services and the Treasury by July 1st, 2024. Advocates of the bill are confident they will receive approval for this measure because the state of Washington received this same approval last year to allow the state to cover undocumented residents.

Since HB 588 passed the House before March 20th, “Crossover Day,” HB 588 is now guaranteed to be considered in the Senate during the final three weeks of the legislative session, which ends April 10th.