,i #aagth ,,congress #ast ,session ,h4 ,r4 #cadi ,,in ,,the ,,house ,,of ,,representatives ,may #ab1 #bjba,ms4 ,jayapal 7for herself1 ,ms4 ,barragn1 ,ms4 ,adams1 ,mr4 ,auchincloss1 ,ms4 ,bass1 ,mr4 ,beyer1 ,mr4 ,blumenauer1 ,ms4 ,bonamici1 ,mr4 ,bowman1 ,ms4 ,bush1 ,mr4 ,crdenas1 ,mr4 ,carson1 ,mr4 ,castro of ,texas1 ,ms4 ,chu1 ,mr4 ,cicilline1 ,ms4 ,clark of ,massachusetts1 ,ms4 ,clarke of ,new ,york1 ,mr4 ,cohen1 ,mr4 ,connolly1 ,mr4 ,correa1 ,mr4 ,danny ,k4 ,davis of ,illinois1 ,mr4 ,de,saulnier1 ,mr4 ,deutch1 ,ms4 ,escobar1 ,mr4 ,espaillat1 ,mr4 ,gallego1 ,mr4 ,garca of ,illinois1 ,ms4 ,garcia of ,texas1 ,mr4 ,gomez1 ,mr4 ,green of ,texas1 ,mr4 ,grijalva1 ,mrs4 ,hayes1 ,ms4 ,jackson ,lee1 ,ms4 ,jacobs of ,california1 ,mr4 ,johnson of ,georgia1 ,mr4 ,jones1 ,mr4 ,keating1 ,mrs4 ,lawrence1 ,ms4 ,lee of ,california1 ,ms4 ,leger ,fernandez1 ,mr4 ,levin of ,michigan1 ,mr4 ,lieu1 ,mr4 ,lowenthal1 ,mrs4 ,carolyn ,b4 ,maloney of ,new ,york1 ,mr4 ,mc,govern1 ,mr4 ,meeks1 ,ms4 ,meng1 ,ms4 ,moore of ,wisconsin1 ,mr4 ,nadler1 ,mrs4 ,napolitano1 ,ms4 ,newman1 ,ms4 ,norton1 ,ms4 ,ocasio-,cortez1 ,ms4 ,omar1 ,mr4 ,panetta1 ,mr4 ,payne1 ,mr4 ,perlmutter1 ,ms4 ,pingree1 ,mr4 ,pocan1 ,ms4 ,pressley1 ,ms4 ,roybal-,allard1 ,mr4 ,rush1 ,ms4 ,scanlon1 ,ms4 ,schakowsky1 ,mr4 ,sires1 ,mr4 ,soto1 ,ms4 ,speier1 ,mr4 ,takano1 ,ms4 ,tlaib1 ,mrs4 ,torres of ,california1 ,mr4 ,torres of ,new ,york1 ,mr4 ,trone1 ,mr4 ,vargas1 ,mr4 ,veasey1 ,mr4 ,vela1 ,ms4 ,velzquez1 ,ms4 ,wasserman ,schultz1 ,mrs4 ,watson ,coleman1 ,mr4 ,welch1 ,ms4 ,williams of ,georgia1 and ,ms4 ,wilson of ,florida7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to expand access to health care services for immigrants by removing legal and policy barriers to health insurance coverage1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,health ,equity and ,access under the ,law for ,immigrant ,families ,act of #bjba or the ,,heal for ,immigrant ,families ,act of #bjba4 #b4 ,findings2 purpose 7a7 ,findings ,congress finds as follows3 7#a7 ,health insurance coverage reduces harmful racial1 economic1 gender1 and health inequities by alleviating cost barriers to1 and increasing utilization of1 necessary health care services1 especially among low-income and underserved populations4 7#b7 ,based solely on their immigration status1 many immigrants and their families face legal and policy restrictions on their ability to obtain affordable health insurance coverage through ,medicaid1 the ,children's ,health ,insurance ,program 7,,chip71 and the health insurance exchanges4 7#c7 ,lack of health insurance coverage contributes to persistent inequities in the prevention1 diagnosis1 and treatment of health conditions4 ,this leads to negative health outcomes for immigrants and their families1 especially ,black1 ,indigenous1 ,latinx1 ,asian1 ,pacific ,islander1 and other ,immigrants of ,color4 7#d7 ,black immigrant women often cite cost as a major barrier to health care4 ,many who are undocumented forgo doctor visits altogether due to the financial burden in addition to consistent racial bias by medical practitioners and racism in health care4 7#e7 ,nearly half of immigrant women are of reproductive age4 ,immigrant women1 lesbian1 gay1 bisexual1 transgender1 and queer 7,,lgbtq7 immigrants1 and immigrants with disabilities disproportionately live in households with low incomes and lack health insurance coverage4 ,legal and policy barriers to affordable health insurance coverage significantly exacerbate their risk of negative pregnancy-related and other reproductive and sexual health outcomes1 with lasting health and economic consequences for immigrant women1 ,,lgbtq immigrants1 immigrants with disabilities1 and their families and society as a whole4 7#f7 ,immigrants who identify as ,,lgbtq experience compounding discrimination from health care providers and systems based on race and ethnicity1 primary language1 immigration status1 sexual orientation1 and gender identity4 ,nearly one in five transgender patients have been refused care due to their gender non-conforming status1 and providers have denied care to undocumented immigrants because of immigration status4 ,these inequities are exacerbated by legal and policy barriers that restrict access to health coverage on the basis of immigration status1 exposing ,,lgbtq immigrant communities to disproportionate gaps in affordable1 comprehensive health care4 ,these compounding barriers are especially harmful for ,,lgbtq immigrants who are escaping interpersonal and state violence due to their sexual orientation and gender identity4 7#g7 ,denying health insurance coverage or imposing waiting periods for health insurance coverage on the basis of immigration status unfairly hinders immigrants' ability to reach and maintain their optimal levels of health and undermines the economic well-being of their families4 7#h7 ,international human rights standards hold that governments have an affirmative obligation to ensure that everyone1 including immigrants1 can access safe1 respectful1 culturally and linguistically appropriate1 and high-quality pregnancy-related care1 including postpartum care1 free from discrimination or violence4 ,medicaid is the nation's single largest payer for pregnancy-related care4 ,nevertheless1 barriers to health coverage persist for pregnant and postpartum people1 particularly immigrants4 7#i7 ,immigrants--especially ,black1 ,indigenous1 ,latinx1 ,asian1 and ,pacific ,islander immigrants--are among those most harmed by the ,united ,states' pregnancy-related morbidity and mortality epidemic1 which is the worst among high-income nations4 ,black people are nearly four times more likely than white people to suffer pregnancy-related death1 and twice as likely to suffer maternal morbidity4 ,indigenous people are two and a half times more likely than white people to die from a pregnancy-related death4 ,the majority of ,united ,states pregnancy-related deaths are preventable4 ,lack of access to health care1 immigration status1 poverty1 and exposure to racism1 sexism1 and xenophobia in and beyond the health care system contribute to the disproportionately high number of pregnancy-related deaths among ,,bipoc birthing and postpartum people4 ,unnecessary barriers that limit pregnant and postpartum immigrants' access to health care undermine their health1 safety1 and human rights4 7#aj7 ,one in seven ,united ,states residents is foreign-born1 approximately one in four children in the ,united ,states has at least one immigrant parent1 and the population of immigrant families in the ,united ,states is expected to continue to grow in the coming years4 ,it is therefore in our collective public health and economic interest to remove legal and policy barriers to affordable health insurance coverage that are based on immigration status4 7#aa7 ,although individuals granted relief under the ,deferred ,action for ,childhood ,arrivals 7,,daca7 program are authorized to live and work in the ,united ,states1 they have been unfairly excluded from the definitions of lawfully present and lawfully residing for purposes of health insurance coverage provided through the ,department of ,health and ,human ,services1 including ,medicaid1 ,,chip1 and the health insurance exchanges4 7#ab7 ,since immigration law evolves constantly1 new immigration categories for individuals with federally authorized presence in the ,united ,states may be created4 7#ac7 ,some ,states continue to unwisely restrict ,medicaid access for immigrants who have long resided in the ,united ,states1 fueling significant health inequities and increasing health care costs for individuals and the public4 7#ad7 ,congress restored ,medicaid eligibility for individuals living in the ,united ,states under the ,compacts of ,free ,association as part of bipartisan legislation in ,december #bjbj and should build on that success by ensuring all immigrants can access care4 7b7 ,purpose ,it is the purpose of this ,act to-- 7#a7 ensure that all individuals who are lawfully present in the ,united ,states are eligible for all federally funded health care programs2 7#b7 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 ,act1 ,public ,law #aaa-adh2 7#c7 eliminate the authority for ,states to restrict ,medicaid eligibility for lawful permanent residents2 and 7#d7 eliminate other barriers to accessing ,medicaid1 ,,chip1 and other medical assistance4 #c4 ,removing barriers to health coverage for lawfully residing individuals 7a7 ,medicaid ,section #aijc7v77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7v77#d77 is amended-- 7#a7 by amending subparagraph 7,a7 to read as follows3 7,a7 ,notwithstanding sections #dja7;a71 #djb7;b71 #djc1 and #dba of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif1 a ,state shall provide medical assistance under this title1 to individuals who are lawfully residing in the ,united ,states 7including individuals described in paragraph 7#a71 battered individuals described in section #dca7;c7 of such ,act1 and individuals with an approved or pending application for deferred action or other federally authorized presence71 if they otherwise meet the eligibility requirements for medical assistance under the ,state plan approved under this title 7other than the requirement of the receipt of aid or assistance under title ,,iv1 supplemental security income benefits under title ,,xvi1 or a ,state supplementary payment74 2 7#b7 by amending subparagraph 7,b7 to read as follows3 7,b7 ,no debt shall accrue under an affidavit of support against any sponsor of an individual provided medical assistance under subparagraph 7,a7 on the basis of provision of assistance to such individual and the cost of such assistance shall not be considered as an unreimbursed cost4 2 and 7#c7 in subparagraph 7,c7-- 7,a7 by striking an election by the ,state under subparagraph 7,a7 and inserting the application of subparagraph 7,a72 7,b7 by inserting or be lawfully present after lawfully reside2 and 7,c7 by inserting or present after lawfully residing each place it appears4 7b7 ,,chip ,subparagraph 7,n7 of section #bajg7;e77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a77 is amended to read as follows3 7,n7 ,paragraph 7#d7 of section #aijc7v7 7relating to lawfully present individuals74 4 7c7 ,effective date 7#a7 ,in general ,except as provided in paragraph 7#b71 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 #ij days after such date of enactment4 7#b7 ,exception if state legislation required ,in the case of a ,state plan for medical assistance under title ,,xix1 or a ,state child health plan under title ,,xxi1 of the ,social ,security ,act which the ,secretary of ,health and ,human ,services determines requires ,state legislation 7other than legislation appropriating funds7 in order for the plan to meet the additional requirements imposed by the amendments made by this section1 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 ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of such session shall be deemed to be a separate regular session of the ,state legislature4 #d4 ,consistency in health insurance coverage for individuals with federally authorized presence1 including deferred action 7a7 ,in general ,for purposes of eligibility under any of the provisions described in subsection 7b71 all individuals granted federally authorized presence in the ,united ,states shall be considered to be lawfully present in the ,united ,states4 7b7 ,provisions described ,the provisions described in this subsection are the following3 7#a7 ,exchange eligibility ,section #adaa of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca74 7#b7 ,reduced cost-sharing eligibility ,section #adjb of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjga74 7#c7 ,premium subsidy eligibility ,section #cf;,b of the ,internal ,revenue ,code of #aihf 7#bf ,u4,s4,c4 #cf;,b74 7#d7 ,medicaid and chip eligibility ,titles ,,xix and ,,xxi of the ,social ,security ,act1 including under section #aijc7v7 of such ,act 7#db ,u4,s4,c4 #acif;b7v774 7c7 ,effective date 7#a7 ,in general ,subsection 7a7 shall take effect on the date of enactment of this ,act4 7#b7 ,transition through special enrollment period ,in the case of an individual described in subsection 7a7 who1 before the first day of the first annual open enrollment period under subparagraph 7,b7 of section #acaa7;c77#f7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;c77#f77 beginning after the date of enactment of this ,act1 is granted federally authorized presence in the ,united ,states and who1 as a result of such subsection1 qualifies for a subsidy under a provision described in paragraph 7#b7 or 7#c7 of subsection 7b71 the ,secretary of ,health and ,human ,services shall establish a special enrollment period under subparagraph 7,c7 of such section #acaa7;c77#f7 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 subsidy4 ,for such an individual who has been granted federally authorized presence in the ,united ,states as of the date of enactment of this ,act1 such special enrollment period shall begin not later than #ij days after such date of enactment4 ,nothing in this paragraph shall be construed as affecting the authority of the ,secretary to establish additional special enrollment periods under such subparagraph 7,c74 #e4 ,removing citizenship and immigration barriers to access to affordable health care under the ,,aca 7a7 ,in general 7#a7 ,premium tax credits ,section #cf;,b of the ,internal ,revenue ,code of #aihf is amended-- 7,a7 in subsection 7c77#a77;,b7-- 7i7 by amending the heading to read as follows3 ,special rule for certain individuals ineligible for medicaid due to status2 and 7ii7 by amending clause 7ii7 to read as follows3 7ii7 the taxpayer is a noncitizen who is not eligible for the ,medicaid program under title ,,xix of the ,social ,security ,act by reason of the individual's immigration status1 4 7,b7 by striking subsection 7e74 7#b7 ,cost-sharing reductions ,section #adjb of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjga7 is amended by striking subsection 7e7 and redesignating subsection 7f7 as subsection 7e74 7#c7 ,basic health program eligibility ,section #acca7;e77#a77;,b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjea7;e77#a77;,b77 is amended by striking lawfully present in the ,united ,states14 7#d7 ,restrictions on federal payments ,section #adab of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjhb7 is amended by striking subsection 7d7 and redesignating subsection 7e7 as subsection 7d74 7#e7 ,requirement to maintain minimum essential coverage ,subsection 7d7 of section #ejjj;,a of the ,internal ,revenue ,code of #aihf is amended by striking paragraph 7#c7 and by redesignating paragraph 7#d7 as paragraph 7#c74 7b7 ,conforming amendments 7#a7 ,establishment of program ,section #adaa7;a7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjha7;a77 is amended by striking paragraph 7#a7 and redesignating paragraphs 7#b71 7#c71 and 7#d7 as paragraphs 7#a71 7#b71 and 7#c71 respectively4 7#b7 ,qualified individuals ,section #acab7;f7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjcb7;f77 is amended-- 7,a7 in the heading1 by striking 2 access limited to citizens and lawful residents2 and 7,b7 by striking paragraph 7#c74 7c7 ,effective date ,the amendments made by this section shall apply to years1 plan years1 and taxable years1 as applicable1 beginning after ,december #ca1 #bjba4 #f4 ,preserving access to coverage 7a7 ,in general ,nothing in this ,act1 including the amendments made by this ,act1 shall prevent lawfully present noncitizens who are ineligible for full benefits under the ,medicaid program under title ,,xix of the ,social ,security ,act from securing a credit for which such lawfully present noncitizens would be eligible under section #cf;,b7c77#a77;,b7 of the ,internal ,revenue ,code of #aihf and under the ,medicaid provisions for lawfully present noncitizens1 as in effect on the date prior to the date of enactment of this ,act4 7b7 ,definition ,for purposes of subsection 7a71 the term full benefits means1 with respect to an individual and ,state1 medical assistance for all services covered under the ,state plan under title ,,xix of the ,social ,security ,act that is not less in amount1 duration1 or scope1 or is determined by the ,secretary of ,health and ,human ,services to be substantially equivalent to the medical assistance available for an individual described in section #aijb7;a77#aj77;,a77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77i774