,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #dgja  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,octob] #af1 #bjai,ms4
 ,jayapal 7= h]self1 ,ms4 ,haal&1 ,ms4  
,b>ragn1 ,mr4 ,blum5au]1 ,ms4 ,judy ,*u 
( ,cali=nia1 ,mr4 ,espaillat1 ,mr4      
,gallego1 ,ms4 ,lee ( ,cali=nia1 ,ms4   
,moore1 ,mrs4 ,napolitano1 ,ms4 ,norton1
 ,mr4 ,pocan1 ,ms4 ,pressley1 ,ms4      
,s*ak[sky1 ,mr4 ,soto1 ,ms4 ,wilson (   
,florida1 ,mr4 ,takano1 ,mrs4 ,lawr5ce1 
,ms4 ,g>cia ( ,texas1 ,mr4 ,johnson (   
,georgia1 ,ms4 ,m5g1 ,ms4               
,roybal-,all>d1 & ,mr4 ,grijalva7       
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,en]gy & ,comm]ce1 & 9 
addition to ! ,committee on ,ways &     
,means1 = a p]iod to be subsequ5tly     
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to exp& access to heal? c>e   
s]vices1 includ+ sexual1 reproductive1 &
 mat]nal heal? s]vices1 = immigrants by 
remov+ legal & policy b>ri]s to heal?   

insurance cov]age1 & = o!r purposes4    
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,heal? ,equity & ,access "u ! ,law =  
,immigrant ,wom5 & ,families ,act (     
#bjai or z ! ,,heal = ,immigrant ,wom5 &
 ,families ,act ( #bjai4  #b4 ,f9d+s2   
purpose  7a7 ,f9d+s ,congress f9ds z    
foll[s3  7#a7 ,heal? insurance cov]age  
r$uces h>mful disp>ities by alleviat+   
co/ b>ri]s to & increas+ utilization (  
necess>y heal? c>e s]vices1 especially  
among l[-income & und]s]v$ populations1 
includ+ wom54  7#b7 ,bas$ solely on _!  
immigration /atus1 _m immigrants & _!   
families face legal & policy re/rictions
 on _! ability to obta9 af=dable heal?  
insurance cov]age ?r\gh ,m$icaid1 !     
,*ildr5's ,heal? ,insurance ,program    
7,,*ip71 & ! heal? insurance ex*anges4  
7#c7 ,lack ( heal? insurance cov]age    
contributes to p]si/5t disp>ities 9 !   
prev5tion1 diagnosis1 & treatm5t (      
negative heal? outcomes exp]i5c$ by     
immigrants & _! families4  7#d7 ,ne>ly  
half ( immigrant wom5 are ( reproductive

 age4 ,immigrant wom5 are also          
disproportionately liv+ 9 l[-income     
h\seholds & lack+ heal? insurance       
cov]age4 ,legal & policy b>ri]s to      
af=dable heal? insurance cov]age !re=e  
p>ticul>ly exac]bate _! risk ( negative 
sexual1 reproductive1 & mat]nal heal?   
outcomes1 ) la/+ heal? & economic       
consequ5ces = immigrant wom51 _!        
families1 & society z a :ole4  7#e7     
,d5y+ heal? insurance cov]age or impos+ 
wait+ p]iods = heal? insurance cov]age  
unfairly h9d]s ! ability ( immigrants to
 atta9 good heal? & und]m9es ! economic 
well-be+ ( _! families4  7#f7 ,!        
population ( immigrant families 9 !     
,unit$ ,/ates is expect$ to cont9ue to  
gr[4 ,"o 9 sev5 ,unit$ ,/ates resid5ts  
is =eign-born1 & approximately "o 9 f\r 
*ildr5 9 ! ,unit$ ,/ates has at lea/ "o 
immigrant p>5t4 ,x is !re=e 9 !         
,nation's %>$ public heal? & economic   
int]e/ to remove legal & policy b>ri]s  
to af=dable heal? insurance cov]age bas$
 on immigration /atus4  7#g7 ,al?\gh    

,def]r$ ,action = ,*ildhood ,arrivals   
7,,daca7 recipi5ts are au?oriz$ to live 
& "w 9 ! ,unit$ ,/ates1 !y h be5        
unfairly exclud$ f ! def9ition (        
lawfully pres5t & lawfully resid+ =     
purposes ( heal? insurance cov]age ?r\gh
 ! ,dep>tm5t ( ,heal? & ,human ,s]vices1
 includ+ ,m$icaid & ,,*ip1 & ! heal?    
insurance ex*anges4  7#h7 ,immigration  
law is con/antly evolv+ & new           
immigration categories = individuals )  
f$]ally au?oriz$ pres5ce 9 ! ,unit$     
,/ates may be creat$4  7b7 ,purpose ,x  
is ! purpose ( ?is ,act to-- 7#a7 ensure
 t all individuals :o are lawfully      
pres5t 9 ! ,unit$ ,/ates are eligible = 
all f$]ally fund$ heal? c>e programs2 & 
7#b7 advance ! ability ( undocum5t$     
individuals to obta9 heal? insurance    
cov]age ?r\gh ! heal? insurance         
ex*anges4  #c4 ,remov+ b>ri]s to heal?  
cov]age = lawfully pres5t individuals   
7a7 ,m$icaid ,section #aijc7v77#d7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acif;b7v77#d77 is am5d$-- 7#a7 by am5d+

 subp>agraph 7,a7 to read z foll[s3     
7,a7 ,not)/&+ sections #dja7;a71        
#djb7;b71 #djc1 & #dba ( ! ,p]sonal     
,responsibility & ,"w ,opportunity      
,reconciliation ,act ( #aiif1 paym5t    
%all be made "u ?is section = c>e &     
s]vices t are furni%$ to individuals :o 
are n citiz5s ( ! ,unit$ ,/ates1 includ+
 ali5s describ$ 9 p>agraph 7#a71 if !y  
o!rwise meet ! eligibility requirem5ts =
 m$ical assi/ance "u ! ,/ate plan       
approv$ "u ?is title 7o!r ?an !         
requirem5t ( ! receipt ( aid or         
assi/ance "u title ,,iv1 supplem5tal    
security income b5efits "u title ,,xvi1 
or a ,/ate supplem5t>y paym5t7 & are    
lawfully pres5t 9 ! ,unit$ ,/ates       
7includ+ su* an individual :o is grant$ 
def]r$ action or o!r f$]ally au?oriz$   
pres5ce74  2  7#b7 9 subp>agraph 7,b7-- 
7,a7 by /rik+ a ,/ate t has elect$ to   
provide m$ical assi/ance to a category (
 ali5s "u subp>agraph 7,a7 & ins]t+     
individuals provid$ m$ical assi/ance    
pursuant to subp>agraph 7,a72 &  7,b7 by

 /rik+ su* an ali5 on ! basis (         
provision ( assi/ance to su* category & 
ins]t+ su* an individual on ! basis (   
provision ( assi/ance to su* individual2
 &  7#c7 9 subp>agraph 7,c7--  7,a7 by  
/rik+ an election by ! ,/ate "u         
subp>agraph 7,a7 & ins]t+ ! application 
( subp>agraph 7,a72  7,b7 by ins]t+ or  
be lawfully pres5t aft] lawfully reside2
 &  7,c7 by ins]t+ or pres5t aft]       
lawfully resid+ ea* place x appe>s4  7b7
 ,,*ip ,subp>agraph 7,n7 ( section      
#bajg7;e77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acig;gg7e77#a77 is     
am5d$ to read z foll[s3  7,n7 ,p>agraph 
7#d7 ( section #aijc7v7 7relat+ to      
lawfully pres5t individuals74  4  7c7   
,effective date  7#a7 ,9 g5]al ,except z
 provid$ 9 p>agraph 7#b71 ! am5dm5ts    
made by ?is section %all take effect on 
! date ( enactm5t ( ?is ,act & %all     
apply to s]vices furni%$ on or aft] !   
date t is #ij days aft] su* date (      
enactm5t4  7#b7 ,exception if ,/ate     
legislation requir$ ,9 ! case ( a ,/ate 

plan = m$ical assi/ance "u title ,,xix1 
or a ,/ate *ild heal? plan "u title     
,,xxi1 ( ! ,social ,security ,act :i* ! 
,secret>y ( ,heal? & ,human ,s]vices    
det]m9es requires ,/ate legislation 7o!r
 ?an legislation appropriat+ funds7 9   
ord] = ! plan to meet ! additional      
requirem5ts impos$ by ! am5dm5ts made by
 ?is section1 ! respective ,/ate plan   
%all n be reg>d$ z fail+ to comply ) !  
requirem5ts ( su* title solely on !     
basis ( its failure to meet ^!          
additional requirem5ts be=e ! fir/ day (
 ! fir/ cal5d> qu>t] beg9n+ aft] ! close
 ( ! fir/ regul> session ( ! ,/ate      
legislature t beg9s aft] ! date (       
enactm5t ( ?is ,act4 ,= purposes ( !    
previ\s s5t5ce1 9 ! case ( a ,/ate t has
 a #b-ye> legislative session1 ea* ye> (
 su* session %all be deem$ to be a      
sep>ate regul> session ( ! ,/ate        
legislature4  #d4 ,consi/5cy 9 heal?    
insurance cov]age = individuals )       
f$]ally au?oriz$ pres5ce1 includ+ def]r$
 action  7a7 ,9 g5]al ,= purposes (     

eligibility "u any ( ! provisions       
describ$ 9 subsection 7b71 all          
individuals grant$ f$]ally au?oriz$     
pres5ce 9 ! ,unit$ ,/ates %all be       
consid]$ to be lawfully pres5t 9 !      
,unit$ ,/ates4  7b7 ,provisions describ$
 ,! provisions describ$ 9 ?is subsection
 are ! foll[+3 7#a7 ,ex*ange eligibility
 ,section #acaa ( ! ,pati5t ,protection 
& ,af=dable ,c>e ,act 7#db ,u4,s4,c4    
#ahjca74  7#b7 ,r$uc$ co/-%>+           
eligibility ,section #adjb ( ! ,pati5t  
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjga74  7#c7 ,premium       
subsidy eligibility ,section #cf;,b ( ! 
,int]nal ,rev5ue ,code ( #aihf 7#bf     
,u4,s4,c4 #cf;,b74  7#d7 ,m$icaid &     
,,*ip eligibility ,titles ,,xix & ,,xxi 
( ! ,social ,security ,act1 includ+ "u  
section #aijc7v7 ( su* ,act 7#db        
,u4,s4,c4 #acif;b7v774  7c7 ,effective  
date  7#a7 ,9 g5]al ,subsection 7a7 %all
 take effect on ! date ( enactm5t ( ?is 
,act4  7#b7 ,transition ?r\gh special   
enrollm5t p]iod ,9 ! case ( an          

individual describ$ 9 subsection 7a7 :o1
 be=e ! fir/ day ( ! fir/ annual op5    
enrollm5t p]iod "u subp>agraph 7,b7 (   
section #acaa7;c77#f7 ( ! ,pati5t       
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjca7;c77#f77 beg9n+ aft] ! 
date ( enactm5t ( ?is ,act1 is grant$   
f$]ally au?oriz$ pres5ce 9 ! ,unit$     
,/ates & :o1 z a result ( su*           
subsection1 qualifies = a subsidy "u a  
provision describ$ 9 p>agraph 7#b7 or   
7#c7 ( subsection 7b71 ! ,secret>y (    
,heal? & ,human ,s]vices %all e/abli% a 
special enrollm5t p]iod "u subp>agraph  
7,c7 ( su* section #acaa7;c77#f7 dur+   
:i* su* individual may enroll 9 qualifi$
 heal? plans ?r\gh ,ex*anges "u title ,i
 ( ! ,pati5t ,protection & ,af=dable    
,c>e ,act & qualify = su* a subsidy4 ,= 
su* an individual :o has be5 grant$     
f$]ally au?oriz$ pres5ce 9 ! ,unit$     
,/ates z ( ! date ( enactm5t ( ?is ,act1
 su* special enrollm5t p]iod %all beg9 n
 lat] ?an #ij days aft] su* date (      
enactm5t4 ,no?+ 9 ?is p>agraph %all be  

con/ru$ z affect+ ! au?ority ( !        
,secret>y to e/abli% additional special 
enrollm5t p]iods "u su* subp>agraph     
7,c74  #e4 ,remov+ citiz5%ip &          
immigration b>ri]s to access to af=dable
 heal? c>e "u ! ,,aca  7a7 ,9 g5]al     
7#a7 ,premium tax cr$its ,section #cf;,b
 ( ! ,int]nal ,rev5ue ,code ( #aihf is  
am5d$-- 7,a7 9 subsection 7c77#a77;,b7--
  7i7 by am5d+ ! head+ to read z foll[s3
 ,special rule = c]ta9 individuals      
ineligible = ,m$icaid due to /atus2 &   
7ii7 9 clause 7ii71 by /rik+ lawfully   
pres5t 9 ! ,unit$ ,/ates1 b & ins]t+ :o2
 &  7,b7 by /rik+ subsection 7e74  7#b7 
,co/-%>+ r$uctions ,section #adjb ( !   
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #ahjga7 is am5d$ by 
/rik+ subsection 7e7 & r$esignat+       
subsection 7f7 z subsection 7e74  7#c7  
,basic heal? program eligibility        
,section #acca7;e77#a77;,b7 ( ! ,pati5t 
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjea7;e77#a77;,b77 is am5d$ 
by /rik+ lawfully pres5t 9 ! ,unit$     

,/ates14  7#d7 ,re/rictions on ,f$]al   
paym5ts ,section #adab ( ! ,pati5t      
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjhb7 is am5d$ by /rik+     
subsection 7d7 & r$esignat+ subsection  
7e7 z subsection 7d74  7#e7 ,requirem5t 
to ma9ta9 m9imum ess5tial cov]age       
,subsection 7d7 ( section #ejjj;,a ( !  
,int]nal ,rev5ue ,code ( #aihf is am5d$ 
by /rik+ p>agraph 7#c7 & by r$esignat+  
p>agraph 7#d7 z p>agraph 7#c74  7b7     
,con=m+ am5dm5ts  7#a7 ,e/abli%m5t (    
program ,section #adaa7;a7 ( ! ,pati5t  
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjha7;a77 is am5d$ by /rik+ 
p>agraph 7#a7 & r$esignat+ p>agraphs    
7#b71 7#c71 & 7#d7 z p>agraphs 7#a71    
7#b71 & 7#c71 respectively4  7#b7       
,qualifi$ individuals ,section #acab7;f7
 ( ! ,pati5t ,protection & ,af=dable    
,c>e ,act 7#db ,u4,s4,c4 #ahjcb7;f77 is 
am5d$-- 7,a7 9 ! head+1 by /rik+ 2      
,access ,limit$ to ,citiz5s & ,lawful   
,resid5ts2 &  7,b7 by /rik+ p>agraph    
7#c74  7c7 ,effective date ,! am5dm5ts  

made by ?is section %all apply to ye>s1 
plan ye>s1 & taxable ye>s1 z applicable1
 beg9n+ aft] ,decemb] #ca1 #bjbj4