Maryland Rep. Bonnie Cullison discusses stalled effort to provide coverage to undocumented residents


James Sklar


Senate Finance Committee Chair Melony Griffith (D-Prince George’s) recently told Maryland Matters that she would likely not bring House Bill 588, the Access to Care Act, up for a vote in her committee. 

The bill would have allowed qualifying residents residing in the state, regardless of immigration status, to obtain coverage through Maryland’s Health Benefit Exchange, which administers Maryland Health Connection, the state’s health insurance marketplace. 

“It is very disheartening that the bill has not yet been heard by the Senate Finance Committee,” Rep. Bonnie Cullison (D – Montgomery County), the main sponsor of HB 588, told State of Reform. Cullison said they were keeping lines of communication open until the very end of session. 

Once the House passed HB 588 (100-38), Cullison, advocates, and constituents said that they have had numerous meetings with the chair of the Finance Committee about the importance of the bill. Cullison said the chair has publicly expressed concern over the legislation’s potential cost to the state.  

The bill was 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 was estimated that 29,413 individuals would enroll in this new program in 2025 and that this would have increased to 51,380 by 2028.  

Speaking in support of the bill during a previous Senate Finance Committee meeting, Sen. Clarence Lam (D – Anne Arundel) reported that undocumented residents cost the state about $118 million in 2020 from emergency medical services. He said this act would expand access to affordable healthcare for this population, thereby reducing reliance on emergency care and saving money for the state in the long run. 

“We have been unable to convince [Griffith] that the bill before her simply requires the Maryland Health Benefit Exchange to seek a waiver from the federal government to allow all Marylanders, regardless of immigration status, to purchase health coverage through the exchange,” Cullison said. “Any future plans for subsidies would have to be considered by the general assembly before implementation.” 

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

Citing an example of other ways Maryland is seeking to expand coverage, Cullison said the Finance Committee has already passed Senate Bill 806, which would require the Maryland Health Benefit Exchange and Maryland Department of Health to develop a report regarding healthcare and dental coverage for undocumented immigrants. The report would be used to make recommendations to specified committees of the general assembly by Oct 31st, 2023.  

“Millions gained access to coverage thanks to the Affordable Care Act, and MHBE has cut our state’s uninsured rate in half,” Cullison said. “Yet nearly a third of those remaining uninsured Marylanders are tax-paying immigrants. As a state, we have committed ourselves to health equity, including access to affordable health insurance. HB 588 and SB 806 represent supplemental ways to decrease uninsured rates. Both approaches are needed to meet our goal of 100% coverage.”