HR 4104
Health Equity and Access under the Law for Immigrant Families Act of 2025
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Bill overview
The Health Equity and Access under the Law for Immigrant Families Act of 2025 aims to expand access to health insurance for immigrants and their families by removing legal and policy barriers. Specifically, it seeks to make all lawfully present individuals eligible for federal health care programs, expand access to health insurance through the Affordable Care Act exchanges for undocumented immigrants, and eliminate state restrictions on Medicaid eligibility for lawful permanent residents. The bill also addresses barriers in Medicare and CHIP, and modifies premium tax credits and cost-sharing reductions to include noncitizens ineligible for Medicaid due to immigration status.
Key provisions
- Ensures all lawfully present individuals are eligible for federal health care programs.
- Expands access to health insurance exchanges for undocumented immigrants.
- Eliminates state restrictions on Medicaid eligibility for lawful permanent residents.
- Removes barriers to accessing Medicaid, CHIP, and other medical assistance programs.
- Defines ‘lawfully present’ to include individuals with deferred action or other federally authorized presence.
- Modifies premium tax credits to include noncitizens ineligible for Medicaid.
- Allows states to expand Medicaid and CHIP eligibility to individuals without lawful presence.
- Updates Medicare Part A and Part B to include individuals lawfully present in the United States.
Who is affected
- Immigrants and their families
- Undocumented immigrants
- Lawful permanent residents
- Healthcare providers
Sponsors
Official sponsors from legislative records.
Primary sponsor
Cosponsors
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119th CONGRESS — 1st Session
H. R. 4104
IN THE HOUSE OF REPRESENTATIVES
A BILL
To expand access to health insurance coverage for immigrants and their families by removing legal and policy barriers to health insurance coverage, and for other purposes.
This Act may be cited as the Health Equity and Access under the Law for Immigrant Families Act of 2025
.
It is the purpose of this Act to—
ensure that all individuals who are lawfully present in the United States are eligible for all Federally funded health care programs;
advance the ability of undocumented individuals to obtain health insurance coverage through the health insurance exchanges established under part II of the Patient Protection and Affordable Care Act, Public Law 111–148;
eliminate the authority for States to restrict Medicaid eligibility for lawful permanent residents; and
eliminate other barriers to accessing Medicaid, CHIP, and other medical assistance.
Section 1903(v)(4) of the Social Security Act (42 U.S.C. 1396b(v)(4)) is amended—
by amending subparagraph (A) to read as follows:
Notwithstanding sections 401(a), 402(b), 403, and 421 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, a State shall provide medical assistance under this title, to individuals who are lawfully residing in the United States (including individuals described in paragraph (1), battered individuals described in section 431(c) of such Act, and individuals with an approved or pending application for deferred action or other Federally authorized presence), if they otherwise meet the eligibility requirements for medical assistance under the State plan approved under this title (other than the requirement of the receipt of aid or assistance under title IV, supplemental security income benefits under title XVI, or a State supplementary payment).
by amending subparagraph (B) to read as follows:
No debt shall accrue under an affidavit of support against any sponsor of an individual provided medical assistance under subparagraph (A) on the basis of provision of assistance to such individual and the cost of such assistance shall not be considered as an unreimbursed cost.
in subparagraph (C)—
by striking an election by the State under subparagraph (A)
and inserting the application of subparagraph (A)
;
by inserting or be lawfully present
after lawfully reside
; and
by inserting or present
after lawfully residing
each place it appears.
Subparagraph (P) of section 2107(e)(1) of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is amended to read as follows:
Except as provided in paragraph (2), the amendments made by this section shall take effect on the date of enactment of this Act and shall apply to services furnished on or after the date that is 90 days after such date of enactment.
In the case of a State plan for medical assistance under title XIX, or a State child health plan under title XXI, of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by the amendments made by this section, the respective State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.
For purposes of eligibility under any of the provisions described in subsection (b), all individuals granted Federally authorized presence in the United States shall be considered to be lawfully present in the United States.
The provisions described in this subsection are the following:
Section 1411 of the Patient Protection and Affordable Care Act (42 U.S.C. 18031).
Section 1402 of the Patient Protection and Affordable Care Act (42 U.S.C. 18071).
Section 36B of the Internal Revenue Code of 1986 (26 U.S.C. 36B).
Titles XIX and XXI of the Social Security Act, including under section 1903(v) of such Act (42 U.S.C. 1396b(v)).
Subsection (a) shall take effect on the date of enactment of this Act.
In the case of an individual described in subsection (a) who, before the first day of the first annual open enrollment period under subparagraph (B) of section 1311(c)(6) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)(6)) beginning after the date of enactment of this Act, is granted Federally authorized presence in the United States and who, as a result of such subsection, qualifies for a subsidy under a provision described in paragraph (2) or (3) of subsection (b), the Secretary of Health and Human Services shall establish a special enrollment period under subparagraph (C) of such section 1311(c)(6) during which such individual may enroll in qualified health plans through Exchanges under title I of the Patient Protection and Affordable Care Act and qualify for such a subsidy. For such an individual who has been granted Federally authorized presence in the United States as of the date of enactment of this Act, such special enrollment period shall begin not later than 90 days after such date of enactment. Nothing in this paragraph shall be construed as affecting the authority of the Secretary to establish additional special enrollment periods under such subparagraph (C).
Section 36B of the Internal Revenue Code of 1986 is amended—
in subsection (c)(1)(B)—
by amending the heading to read as follows: Special rule for certain individuals ineligible for medicaid due to status
; and
by amending clause (ii) to read as follows:
by striking subsection (e).
Section 1402 of the Patient Protection and Affordable Care Act (42 U.S.C. 18071) is amended by striking subsection (e) and redesignating subsection (f) as subsection (e).
Section 1331(e)(1)(B) of the Patient Protection and Affordable Care Act (42 U.S.C. 18051(e)(1)(B)) is amended by striking lawfully present in the United States,
.
Section 1412 of the Patient Protection and Affordable Care Act (42 U.S.C. 18082) is amended by striking subsection (d) and redesignating subsection (e) as subsection (d).
Subsection (d) of section 5000A of the Internal Revenue Code of 1986 is amended by striking paragraph (3) and by redesignating paragraph (4) as paragraph (3).
Section 1411(a) of the Patient Protection and Affordable Care Act (42 U.S.C. 18081(a)) is amended by striking paragraph (1) and redesignating paragraphs (2), (3), and (4) as paragraphs (1), (2), and (3), respectively.
Section 1312(f) of the Patient Protection and Affordable Care Act (42 U.S.C. 18032(f)) is amended—
in the heading, by striking ; access limited to citizens and lawful residents
; and
by striking paragraph (3).
The amendments made by this section shall apply to years, plan years, and taxable years, as applicable, beginning after December 31, 2025.
in subclause (XXII), by striking or
at the end;
in subclause (XXIII), by striking the semicolon and inserting ; or
; and
by adding at the end the following new subclause:
Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended, in the matter preceding paragraph (1)—
in the matter designated as clause (xvi), by striking or
at the end;
in the matter designated as clause (xvii), by adding or
at the end; and
by inserting after the matter designated as clause (xvii) the following:
Title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.) is amended by inserting after section 2112 the following new section:
A State may elect through an amendment to its State child health plan under section 2102 to treat an individual as a targeted low-income child or a targeted low-income pregnant woman for purposes of this title if such individual would otherwise be included as such a child or such a pregnant woman (as applicable) under such plan if the individual were a citizen of the United States.
The preceding sentence shall not apply with respect to a noncitizen’s eligibility under a State plan (or waiver of such plan) under title XIX of the Social Security Act or under a State child health plan (or waiver of such plan) under title XXI of such Act to the extent that such State has elected to make such individual so eligible pursuant to section 1902(a)(10)(A)(ii)(XXIV) or 2112A of such Act, respectively..
Section 1818(a)(3) of the Social Security Act (42 U.S.C. 1395i–2(a)(3)) is amended by striking an alien
and all that follows through under this section
and inserting an individual who is lawfully present (as defined in section 8(c) of the
.Health Equity and Access under the Law for Immigrant Families Act of 2025
) in the United States, including an individual with an approved or pending application for deferred action or other Federally authorized presence
Section 1836(a)(2) of the Social Security Act (42 U.S.C. 1395o(a)(2)) is amended by striking an alien
and all that follows through under this part
and inserting an individual who is lawfully present (as defined in section 8(c) of the
.Health Equity and Access under the Law for Immigrant Families Act of 2025
) in the United States, including an individual with an approved or pending application for deferred action or other Federally authorized presence
The term lawfully present shall include, at a minimum, all immigration categories that are treated as lawfully present for purposes of the title XIX program as amended by section 3.