Texas policies would restrict proposed federal expansion of healthcare coverage to DACA recipients


Boram Kim


CMS released a notice of proposed rulemaking on Monday that would expand access to healthcare for Deferred Action for Childhood Arrivals (DACA) recipients across all states, if finalized.


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The notice was a follow-up to the Biden administration’s announcement earlier this month to expand healthcare coverage to DACA recipients under the Medicaid program and Affordable Care Act (ACA) exchanges. 

The proposal would allow immigrants illegally brought to the US as children to access health insurance as lawfully present immigrants. DACA protects these individuals, known as Dreamers, from deportation.

“DACA recipients, like all Dreamers, are Americans, plain and simple,” HHS Secretary Xavier Becerra said in a statement. “The United States is their home, and they should enjoy the same access to healthcare as their fellow Americans.

Every day, nearly 580,000 DACA recipients wake up and serve their communities, often working in essential roles and making tremendous contributions to our country. They deserve access to healthcare, which will provide them with peace of mind and security.”

Some 100,000 DACA recipients live in Texas—33,000 in Houston alone. While the ACA brought new rules and opportunities for non-US citizens to access private and public health coverage options in 2014, local immigration advocates say current Texas law created unintended consequences and barriers to care for immigrants.

Texas remains one of several states to deny Medicaid coverage to both undocumented and lawfully present (those who entered the country on or after August 22, 1996) adult immigrants. Even if the federal plan is approved, Texas Medicaid policies would severely restrict access for these individuals because the state has yet to expand Medicaid under the ACA. 

Legal residents face significant technological and legal barriers related to both public coverage and private insurance while undocumented residents are excluded altogether from public insurance programs with the exception of some emergency services under Medicaid. 

Speaking to State of Reform, Anne Dunkelberg, senior fellow on health and food justice at Every Texan, said that while the proposed rules would expand commercial coverage to Texas Dreamers through the ACA, the expanded Medicaid coverage for DACA recipients would not apply in Texas.

“Texas doesn’t cover lawfully present adult immigrants,” Dunkelberg said. “In addition to not having Medicaid expansion, we’re one of only seven states that doesn’t basically cover illegal immigrant adults. Whether you’re getting down in the weeds about which [DACA recipients] fall in the qualified immigrant [category] and which ones fall in the lawfully present—bottom line is we don’t let either of those groups get access to Medicaid in Texas.

The big change for DACA would be, [recipients] now can get access to the dramatically more generous subsidies and out-of-pocket limits that have been initiated in the last couple of years that drove up our ACA enrollment so much in the marketplace for 2023 coverage.”

A federal judge declared DACA illegal in 2021 after Texas and eight other states filed a lawsuit claiming financial harm in healthcare, education, and other costs. A 2022 decision ended the pathway for new entrants into DACA but allowed for a two-year renewal process to remain in place for those already in the program. 

United We Dream, an immigrant youth-led advocacy group, told State of Reform it has established a resource for DACA recipients in Texas that will be updated as the rules become finalized. An official from the organization said it will be working to update members in Texas and across the country on the final rules and policy implementation.