For Medicaid, CHIP, and BHP, we assume at least one person from every State agency and territory would review for applicability; at least two additional people from the 35 States, the District of Columbia, and three territories that have elected the CHIPRA 214 option would review; and at least one person from the two States with BHPs would also review, for a total of 134 individuals for Medicaid, CHIP, and BHP. 18071(e). Document page views are updated periodically throughout the day and are cumulative counts for this document. By doing so, we complied with the requirements of E.O. The following proposed changes will be submitted to OMB for review under OMB control number 09381218 (CMS10510). As discussed previously, in paragraph (9) of the proposed definition of lawfully present at 45 CFR 155.20, we propose an additional clause clarifying that all recipients of deferred action, including DACA recipients, are lawfully present for purposes of 45 CFR part 155, which concerns eligibility to enroll in a QHP through an Exchange, and by cross-reference at 42 CFR 600.5, eligibility for a BHP. 18051(e). We ask readers to log in so that we can recognize you as a registered user and give you unrestricted access to our website. %PDF-1.6 % Copyright 2023 America Press Inc. | All Rights Reserved. Document Drafting Handbook Preserving and Fortifying Deferred Action for Childhood Arrivals (DACA). The proposed changes to 42 CFR 600.5 would no longer exclude DACA recipients from the definition of lawfully present used to determine eligibility for a BHP in those States that elect to operate the program, if otherwise eligible. We seek comment on these effects and any other potential benefits that may result from the proposals in this rule. Start Printed Page 25317 23. Relevant information about this document from Regulations.gov provides additional context. of this proposed rule. Of those 100 hours, we estimate it would take a database and network administrator and architect 25 hours at $98.50 per hour and a computer programmer 75 hours at $92.92 per hour. The Patient Protection and Affordable Care Act (ACA)[1] If you wish to comment, please submit your comments electronically as specified in the DATES and https://doi.org/10.1016/S2468-2667(20)30164-X. As discussed previously, the changes proposed to the definition of lawfully present would impact eligibility for Medicaid and CHIP in States that have elected the CHIPRA 214 option. We seek comment on whether, alternatively, we As discussed previously, the changes proposed to the definition of lawfully present would impact eligibility to enroll in a QHP through an Exchange and for APTC and CSRs. for better understanding how a document is structured but OSC can answer your questions and even call the employer when appropriate. https://www.medicaid.gov/federal-policy-guidance/downloads/sho-12-002.pdf. In this rule, we propose to amend the definition to include individuals who are granted benefits under section 1504 of the LIFE Act Amendments for consistency with DHS's policy to consider such individuals Family Unity beneficiaries. But immigrants living in the U.S. without documentation are far more likely than others to not have health insurance. DACA, an acronym for Deferred Action for Childhood Arrivals, is a policy that protects around 800,000 young people known as "DREAMers" who entered the United States unlawfully as children.The program does not grant them official legal status or a pathway to citizenship, but it does allow them to apply for a driver's license, social security number, and work permit. Fast Facts. The DACA program has been mired in legal challenges for years, while Congress has been unable to reach consensus on broader immigration reforms. Additional enrollment in the BHP, anticipated to be 4,000 individuals in 20242026 and 5,000 individuals in 20272028. informational resource until the Administrative Committee of the Federal She signed up for DACA when she was in college, soon after it was announced in 2012, and then started volunteering to help other Dreamers do the same. Passing the Dream Act is a matter of simple American fairness and justice that would provide Dreamers the sense of stability they deserve and a path to lawful permanent residence.. Theyre American in every way except for on paper, Biden said in a video released on his Twitter page. To Ms. Ruiz, the reason that the Dream Act remains stalled in Congress is not subtle. Mr. Durbin charges that extreme MAGA Republicans are driving the immigration agenda in the House of Representatives. Nevertheless, he says, I am willing to negotiate with anyone who will work with me to protect Dreamers, and if there is a path forward, I will certainly work with my colleagues to get it done., If it succeeds in the 118th Congress, the Dream Act would be overcoming decades of legislative inertia. For now, the Tenth Circuit kept the area court's stay in place, which signifies that current DACA recipients can continue to benefit from DACA and renew own grants of DACA and work authorization for this . https://www.nilc.org/wp-content/uploads/2022/06/NILC_DACA-Report_060122.pdf. In the 2012 SHO, CMS reasoned that because the rationale that DHS offered for adopting the DACA policy did not pertain to eligibility for Medicaid and CHIP, eligibility for these benefits should not be extended as a result of DHS deferring action under DACA. Start Printed Page 25335 Accordingly, based on the proposed changes at 45 CFR 155.20, SIJs could be considered lawfully present under three possible categories, as applicable: paragraph (9) deferred action; paragraph (10) a pending adjustment of status application; or paragraph (13) a pending or approved SIJ petition. Of those 100 hours, we estimate it would take a database and network administrator and architect 25 hours at $98.50 per hour and a computer programmer 75 hours at $92.92 per hour. 18071(e). 17. 42 U.S.C. By including DACA recipients in the definition of lawfully present, this proposed rule is aligned with the goals of the ACAspecifically, to lower the number of people who are uninsured in the United States and make affordable health insurance available to more people. 71. However, given the broad aims of the ACA to increase access to health coverage, we now assess that this rationale for excluding certain noncitizen groups from such coverage was not only not statutorily mandated, it failed to best effectuate congressional intent in the ACA. The need for the information collection and its usefulness in carrying out the proper functions of our agency. The ACA also generally requires that individuals be lawfully present in order to be eligible for insurance affordability programs such as premium tax credits (PTC),[4] Advocacy groups commended the Biden administration for the move. 3. According to a demographic estimate by the Center for Migration Studies, over 200,000 DACA recipients served as essential workers during the COVID19 public health emergency. They came five votes short of 60 needed in the Senate to get it over the finish line [in 2010] [but] five Democrats did not vote for it because of re-election concerns, Mr. Appleby remembers. National Immigration Law Center. . Count of Active DACA Recipients by Month of Current DACA Expiration as of September 30, 2022. One major ally has been Rep. Ann Kirkpatrick, an Arizona Democrat who since 2015 has sponsored stand-alone measures to allow DACA recipients to work for Congress. The Public Inspection page may also Data Collection to Support Eligibility Determinations for Insurance Affordability Programs and Enrollment through Health Benefits Exchanges, Medicaid and CHIP Agencies, OMB control number 09381191 (CMS10440) accounts for burdens associated with the streamlined application for enrollment in the programs impacted by this rule. corresponding official PDF file on govinfo.gov. section of this preamble, and, when we proceed with a subsequent document, we will respond to the comments in the preamble to that document. Start Printed Page 25329 To date, 35 States, the District of Columbia, and three territories have elected the CHIPRA 214 option for at least one population of children or pregnant individuals in their Medicaid or CHIP programs. Please see section II.D.3. We similarly propose a minor technical change in paragraph (5) of the proposed definition of lawfully present at 45 CFR 155.20, as compared to the definition of lawfully present currently in paragraph (4)(ii) at 45 CFR 152.2, to refer to individuals who are granted, rather than currently under Temporary Protected Status (TPS), as this language more accurately refers to how DHS confers this temporary status upon individuals. But despite the courts conservative majority, its not an automatic assumption that theyre gonna strike it down, Mr. Appleby says. In addition, the DHS SAVE verification system generally does not currently return information to requestors on the status of underlying immigrant visa petitions associated with the adjustment of status response. Francis' visit to Hungary is bringing him as close as he's come to the front lines of the war. See https://www.uscis.gov/sites/default/files/document/data/Active_DACA_Recipients_Sept_FY22_qtr4.pdf. Dizioli, Allan and Pinheiro, Roberto. We prepared the economic impact estimates utilizing a baseline of no action, comparing the effect of the proposals against not proposing the rule at all. We discuss how we calculated our BHP enrollment estimates earlier in this RIA. (calculated at 100 percent of salary), and our adjusted hourly wage. Using the hourly value of time for changes in time use for unpaid activities discussed in section IV.A. 20. 7105(b)), relating to certain victims of trafficking; section 602(b)(8) of the Afghan Allies Protection Act of 2009, Public Law 1118 (8 U.S.C. Like Mr. Appleby, she is hoping to see more attention to her plight from U.S. bishops. are not part of the published document itself. Biden, a Democrat, has repeatedly called on Congress to provide a pathway to citizenship for immigrants brought to the U.S. illegally as children. This definition is currently used to determine whether a consumer is eligible to enroll in a QHP through an Exchange and for APTC and CSRs, and whether a consumer is eligible to enroll in a BHP in States that elect to operate a BHP. I went for several years without health insurance wondering if a medical bill was going to send me to bankruptcy or, even worse, lead to passing away early, Magaa-Salgado said. More information and documentation can be found in our We estimate that of the 200,000 individuals impacted by the proposed changes, 98 percent would be applying for insurance affordability programs and 2 percent would be applying without consideration for insurance affordability programs. if you are trying to comment, you must log in or set up a new account. [22] Exchanges would continue to submit requests to verify an applicant's nonimmigrant status through a data match with DHS via the Federal data services hub using DHS' Systematic Alien Verification for Entitlements (SAVE) system. More than a third of DACA recipients are estimated to be without health care coverage, HHS said. As indicated earlier, a BHP is optional for States. 18041, HHS has discretion to determine the best legal interpretations of these terms for purposes of administering its programs. Proposed changes to Medicaid and CHIP under the CHIPRA 214 option and BHP are included under sections II.D. https://www.medicaid.gov/basic-health-program/index.html. You may submit electronic comments on this regulation to This step allows the public to submit comments about the program during a 60-day period, followed by a vetting process before it becomes a federal regulation. It is CMS' intent that if the rules for one program are found unlawful, the rules for other programs would remain intact. The current immigration system in the United States is broken, Mr. Durbin says. https://downloads.cms.gov/cmsgov/archived-downloads/smdl/downloads/sho10006.pdf. The act offers a conditional resident status for Dreamers that protects them from deportation, allows them to work legally in the United States and permits them to travel outside the country. We propose a minor technical modification to the citation in paragraph (7) of the definition of lawfully present to more accurately describe Family Unity beneficiaries. CMS also issued the 2012 SHO excluding DACA recipients from the definition of lawfully residing for purposes of Medicaid or CHIP eligibility under the CHIPRA 214 option. L. 111148) was enacted on March 23, 2010. 36. As of May 7, 2025, non-REAL ID (or "standard") driver's licenses and state ID . National Immigration Law Center. But a partial stay permits DHS to continue processing DACA renewals and related applications for employment authorization documents. SHO #10006: Medicaid and CHIP Coverage of Lawfully Residing Children and Pregnant Women. According to Institute on Taxation and Economic Policy, undocumented immigrants contribute an estimated $11.74 billion to state and local economies each year. Check out some of the. If youre already a subscriber or donor, thank you! 18051, and 42 U.S.C. 1254a; (6) Is granted employment authorization under 8 CFR 274a.12(c); (7) Is a Family Unity beneficiary in accordance with section 301 of Public Law 101649 as amended; or section 1504 of the LIFE Act Amendments of 2000, title XV of H.R. 1101(a)(27)(J); (14) Is lawfully present in American Samoa under the immigration laws of American Samoa; or. Based on our estimates, OIRA has determined that this rulemaking is a significant regulatory action under section 3(f)(1) Executive Order 12866. While developing this rule, we attempted to balance States' interests in running their own Exchanges, BHPs, and Medicaid and CHIP programs with CMS's interest in establishing a consistent definition of lawfully present for use in eligibility determinations across CMS programs. As such, we assume 50 percent of the Medicaid and CHIP application processing costs would fall on the 39 States referenced in section IV.C.1. Start Printed Page 25319 (2016). As of December 2022, those States are California, the District of Columbia, Illinois, Maine, Massachusetts, New York, Oregon, Rhode Island, Vermont, and Washington. https://www.uscis.gov/sites/default/files/document/forms/i-817.pdf. For CHIP, States can claim enhanced FMAP for administrative activities up to 10 percent of the State's total computable expenditures within the State's fiscal year allotment. U.S. Pending such comments, and to ensure alignment across CMS programs, we propose that the Exchange regulations at 45 CFR 155.20 define qualified noncitizen by including a citation to the Medicaid regulations at 42 CFR 435.4, rather than to PRWORA. Taking into account the 50 percent Federal contribution to Medicaid and CHIP program administration, the estimated State one-time cost would be $4,716 per State, and $183,914 in total for all States. She had already interviewed a few times when she found out. These U.S. residents have been suspended in a bureaucratic limbo since the program began under an executive order by President Barack Obama in 2012. House Appropriations Chair Rosa DeLauro, D-Conn., says shell try to amend the rider again this year. should verify the contents of the documents against a final, official If resource use remains the same but different entities in society pay for them, then the estimated effects would instead be transfers. Some argue that DACA recipients' employment authorization renders the program illegal because it converts it from a prosecutorial discretion program to an ultra vires program. 39. Only official editions of the 8. The Public Inspection page DACA recipients are required to pay federal income taxes. has the meaning given in 45 CFR 155.20. of this proposed rule and the costs to consumers as a result of increased information collections associated with this proposal, which include applying for Exchange coverage and submitting additional information to verify their lawful presence, if necessary, are discussed in section IV.C.4. Since 1996, when the Department of Justice's Immigration and Naturalization Service issued an interim final rule defining the term lawfully present as used in the recently enacted PRWORA, Federal agencies have considered deferred action recipients to be lawfully present for purposes of certain Social Security benefits (see https://aspe.hhs.gov/reports/valuing-time-us-department-health-human-services-regulatory-impact-analyses-conceptual-framework. of this proposed rule. These proposed requirements, if finalized, would impose additional costs on States to process the applications for individuals impacted by the proposals in this rule. I cant plan my life in two-year increments, Ms. Ruiz says. [7] Due to high demand for visas in this category, for many applicants it can take several years for a visa number to become available. As discussed further in section IV.C.4. [12] She started that advocacy as a young woman 20 years ago and continues it today as a grandmother to her oldest sons three children. CMS will not post on Muoz Lopez flew to Washington and ran into the Nuns on the Bus, a group of roving advocates sponsored by the Catholic social justice group NETWORK whom she had met earlier on their cross-country tour. 1231, or for relief under the Convention Against Torture; and. 51. 18081(c)(2)(B). 02:55 - Source: CNN. DACA recipients who are not homeowners pay $2.3 billion in rent each year. L. 96354), section 1102(b) of the Act, section 202 of the Unfunded Mandates Reform Act of 1995 (March 22, 1995; Pub. These proposed definitions are solely for the purposes of determining eligibility for specific Department of Health and Human Services (HHS) health programs and are not intended to define lawful presence for purposes of any other law or program. 31. and a 2021 survey by the National Immigration Law Center stating that 34 percent of DACA recipients are uninsured,[63] must meet when it promulgates a proposed rule (and subsequent final rule) that imposes substantial direct requirement costs on State and local governments, preempts State law, or otherwise has federalism implications. Before you can comment, you need to update your profile to include your first and last name, as required in our, Im available to do anything, Pope Francis said. https://www.medicaid.gov/basic-health-program/index.html. Individuals without health insurance are less likely to receive preventative or routine health screenings, and may delay necessary medical care, incurring high costs and debts. This was one year after President Obama, frustrated by the lack of progress in Congress, issued his executive order creating DACA. In this regard, Table 1 presents BLS's mean hourly wage, our estimated cost of fringe benefits and overhead In light of DHS's clarifications, HHS sees no persuasive reasons to treat DACA recipients differently from other noncitizens who have been granted deferred action. In aggregate, we estimate a one-time burden of 3,900 hours (39 States 05/01/2023, 258 We do not believe that this threshold will be reached by the requirements in this proposed rule. of this proposed rule, we estimate that of the 129,000 individuals impacted by the proposals in this rule, 13,000 would enroll in Medicaid or CHIP (10 percent), 112,000 in the Exchanges (87 percent), and 4,000 (3 percent) in the BHPs on average each year, including redeterminations and re-enrollments. Many native-born Americans do not see the positive impact of immigration on their lives, Mr. Appleby says. Jose Magaa-Salgado, founder of the Masa consulting group and a DACA recipient, said that growing up he witnessed his cousin, who was undocumented, be put in hospice and pass away after being diagnosed with cancer because she did not have insurance to help her pay for treatment. Furthermore, the proposals related to Medicaid and CHIP would impact State governments, but as States do not constitute small entities under the statutory definition, an impact analysis for these provisions is not required under the RFA. Citizenship and Immigration Services. Nonetheless, there is no practical alternative, and we believe that doubling the hourly wage to estimate total cost is a reasonably accurate estimation method. covered. States may pursue a waiver under section 1332 of the Affordable Care Act (ACA) that could waive the lawfully present framework in section 1312(f)(3) of the ACA. [57] Jose Muoz, national communications manager for immigration advocacy organization United We Dream, said the announcement was a major victory. He said that until today, hundreds of thousands of people who benefit from DACA have been obligated to pay higher quantities for private insurance if their employers did not offer insurance or they were self-employed, or go uninsured. Before sharing sensitive information, make sure you're on a federal government site. of this proposed rule to stand. The President of the United States manages the operations of the Executive branch of Government through Executive orders. I remember sitting in one of the booths, Muoz Lopez says. Now she works for House Democratic Caucus Vice Chair Pete Aguilar, but if it hadnt been for finding love and getting married making her eligible for a green card a federal career would have been closed to her. The licenses are marked that they cannot be used for federal purposes, like voting. We can't do it without youAmerica Media relies on generous support from our readers. 119), as amended by the Health Care and Education Reconciliation Act of 2010 (Pub. Using the per-application processing burden of 10 minutes (0.17 hours) per application at a rate of $46.70 per hour, this results in a burden of 15,677 hours, or $732,135, for State Exchanges and 13,903 hours, or $649,251, for the Federal Government. 4. Its not as if the general public has turned its back on the idea, Mr. Appleby says, noting surveys that demonstrate strong and consistent public support for addressing the plight of Dreamers. Similarly, for purposes of BHP eligibility, COFA migrants are not considered qualified noncitizens by cross-referencing the BHP definition of lawfully present at 42 CFR 600.5 to 45 CFR 155.20. 1806(e)(6). Under this proposed change, we estimate that approximately 129,000 DACA recipients would enroll in a QHP through an Exchange, a BHP, or Medicaid or CHIP under the CHIPRA 214 option. It is not limited to noncitizens with a pending application for adjustment of status based on an approved SIJ petition. We seek comment on these estimates and the assumptions and methodology used to calculate them. Based on a 2021 survey from the National Immigration Law Center,[72] The Problem Solvers Caucus has put forth a reasonable proposal that recognizes that we must address the restrictive budget caps and addresses key immigration problems by allowing DACA recipients to continue contributing to American society, along with strengthening our border security. Kevin Clarke is Americas chief correspondent and the author of Oscar Romero: Love Must Win Out (Liturgical Press). L. 111152), which amended and revised several provisions of the Patient Protection and Affordable Care Act, was enacted on March 30, 2010. Start Printed Page 25333 22. Now, about 580,000 people remain, as some have dropped out and many others have found ways to naturalization or permanent residency on their own, through marriage or military service or along other paths that normalized their status. Agencies review all submissions and may choose to redact, or withhold, certain submissions (or portions thereof). https://doi.org/10.1186/s12879-020-05587-2. Because noncitizens who are treated as refugees for purposes of Medicaid eligibility are also treated as refugees for purposes of CHIP eligibility, these categories of noncitizens (discussed previously in this proposed rule) are also being considered for the definition of qualified noncitizen for purposes of CHIP. As discussed in section IV.B. A year later, she decided to stay. In March 2012, CMS issued regulations regarding eligibility to enroll in a QHP through an Exchange that cross-referenced the definition of lawfully present set forth in the 2010 PCIP regulations (77 FR 18309). This site displays a prototype of a Web 2.0 version of the daily legislation that was not codified in 8 U.S.C. This proposed amendment is also a technical change, and although we anticipate the number of individuals who would be substantively impacted by this proposal would be small, we do not have a reliable way to quantify these impacts. Health Coverage and Care of Immigrants, Kaiser Family Foundation, We need to give Dreamers the opportunities and support they deserve.. 42 U.S.C. Combined with reviewers for the Exchanges, this results in an estimate of 191 reviewers. The postpartum period for pregnant individuals includes the 60-day period described in sections 1903(v)(4)(A)(i) and 2107(e)(1)(O) of the Act or the extended 12-month period described in sections 1902(e)(16) and 2107(e)(1)(J) of the Act in States that have elected that option. has the meaning assigned at 435.4 of this chapter, except that State residency requirements must be consistent with paragraph (e) of this section. And the government increased federal subsidies to drive down the cost of insurance plans on the Affordable Care Acts marketplace. Start Printed Page 25315 Households containing DACA recipients have $24 billion in after-tax spending power. Information about this document as published in the Federal Register. A federal judge in Texas on Friday ruled that the Deferred Action for Childhood Arrivals program is unlawful. https://www.bls.gov/oes/current/oes_nat.htm). We seek comment on this assumption. Section 152.2 is amended by revising the definition of Lawfully present to read as follows: Lawfully present has no substantive legal effect. 1641(b) or (c). In fact, according to FWD.us, an immigration reform advocacy group, during the Covid-19 crisis, DACA recipients represented 200,000 of the essential workers who were regularly lauded by politicians throughout the pandemic, including nearly 30,000 health care workers. 18. Since the program was created, hundreds of thousands of new Dreamers have come of age in the United States without recourse to DACA protection. https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/. [61] postpartum period,[67] We multiplied this by 12 months per FY and by the number of enrollees to arrive at annual costs. through IV.C.4. CMS is committed to working with State agencies and providing technical assistance regarding implementation of these proposed changes, if finalized. [25] In response, DHS noted that it did not have the authority to make changes to the definitions of lawfully present used to determine eligibility for insurance affordability programs and affirmed that such authority rests with HHS (87 FR 53152). on Therefore, at least one person from each of the three State Exchanges on the Federal platform would review for applicability, and at least three people from each of the 18 State Exchanges would review, for a total of 57 individuals for the Exchanges. To calculate costs, we estimated the per enrollee costs in Medicaid for pregnant individuals and children based on the projections in the President's Fiscal Year (FY) 2024 Budget. We rely on them to help keep our economy running, care for our loved ones and provide services in our community. This document has been published in the Federal Register. While the U.S. Supreme Court's decision on June 18, 2020 should have restored the Deferred Action for Childhood Arrivals (DACA) program in its entirety, a recent announcement by the Trump administration has once again thrown the program and DACA recipients into limbo. In a recent rulemaking, DHS referred to its definition of lawful presence in 8 CFR 1.3, reiterating that it is a specialized term of art that does not confer lawful status or authorization to remain in the United States, but instead describes noncitizens who are eligible for certain benefits as set forth in 8 U.S.C.
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