State-Funded Affordable Health Coverage for Non-Citizen Populations

Laura Buddenbaum, State Health and Value Strategies

Although the Affordable Care Act made significant strides in expanding health coverage and has ushered in the highest coverage rates in history, a key population continues to be uninsured at disproportionately high levels. Non-citizen populations, including individuals who are lawfully present and those who are undocumented, make up a significant portion of the nation’s uninsured, limiting their access to care and worsening health disparities. As of 2023, about 50% of individuals who are undocumented and 18% of those who are lawfully present are uninsured, as compared to 8% of U.S.-born citizens. In an effort to expand coverage to certain non-citizens, on May 3, 2024 the U.S Department of Health and Human released a final regulation that allows people who receive Deferred Action for Childhood Arrivals (DACA) to sign up for subsidized Marketplace or Basic Health Program (BHP) coverage.

At the state level, efforts to expand health coverage to non-citizen populations is gaining momentum. State Health and Value Strategies has been tracking state actions to provide affordable health coverage for non-citizen populations. The map below highlights both existing programs and programs that are under development to provide state-funded coverage for low-income non-citizen children, adults, or individuals with specific immigration statuses, such as individuals who are DACA recipients. States are using different vehicles to establish these coverage programs, including:

• Medicaid or Children’s Health Insurance Program (CHIP) look-alike programs that are funded with state-only dollars for low-income residents who meet all Medicaid and CHIP eligibility requirements except for immigration status (referred to as “Medicaid-like” below).
• Utilizing a section 1332 state innovation waiver, that has been approved by the Centers for Medicare & Medicaid Services (CMS), to allow people who are undocumented to purchase a qualified health plan through the state’s health insurance Marketplace with a state-based subsidy for low-income populations.
• Establishing a Marketplace-like portal, separate from the state’s existing Marketplace, to allow undocumented populations to purchase off-exchange coverage with a state-based subsidy for low-income populations (referred to as “Marketplace-like” below).
• Leveraging another commercial coverage product to provide subsidized enrollment outside of the individual market, such as a BHP designed for low-income populations up to 200% of the federal poverty level (FPL). 

All states are required to provide limited Emergency Medicaid coverage for individuals who meet other Medicaid eligibility requirements except for immigration status. While federal funding is also available to expand coverage to some non-citizen populations, including pregnant individuals and children, not all states have taken up this option and these programs are not featured below.

The map includes descriptions of each state’s coverage program or initiative, the vehicle through which the program has been established (e.g., Medicaid-like, Marketplace-like), if the program provides limited coverage only (such as coverage for only preventive care services), and if the program has not yet been implemented. A brief description of the implementation history is also provided.

State-Funded Coverage Programs for Non-Citizens

Map updated as of 11/14/2024