,i  #aag? ,,congress  #a/ ,session  ,h4 
,r4 #cadi  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,may #ab1 #bjba,ms4   
,jayapal 7= h]self1 ,ms4 ,b>ragn1 ,ms4  
,adams1 ,mr4 ,au*9closs1 ,ms4 ,bass1    
,mr4 ,bey]1 ,mr4 ,blum5au]1 ,ms4        
,bonamici1 ,mr4 ,b[man1 ,ms4 ,bu%1 ,mr4 
,crd5as1 ,mr4 ,c>son1 ,mr4 ,ca/ro (     
,texas1 ,ms4 ,*u1 ,mr4 ,cicill9e1 ,ms4  
,cl>k ( ,massa*usetts1 ,ms4 ,cl>ke (    
,new ,york1 ,mr4 ,coh51 ,mr4 ,connolly1 
,mr4 ,correa1 ,mr4 ,danny ,k4 ,davis (  
,ill9ois1 ,mr4 ,de,saulnier1 ,mr4       
,deut*1 ,ms4 ,escob>1 ,mr4 ,espaillat1  
,mr4 ,gallego1 ,mr4 ,g>ca ( ,ill9ois1   
,ms4 ,g>cia ( ,texas1 ,mr4 ,gomez1 ,mr4 
,gre5 ( ,texas1 ,mr4 ,grijalva1 ,mrs4   
,hayes1 ,ms4 ,jackson ,lee1 ,ms4 ,jacobs
 ( ,cali=nia1 ,mr4 ,johnson ( ,georgia1 
,mr4 ,jones1 ,mr4 ,keat+1 ,mrs4         
,lawr5ce1 ,ms4 ,lee ( ,cali=nia1 ,ms4   
,leg] ,f]n&ez1 ,mr4 ,lev9 ( ,mi*igan1   
,mr4 ,lieu1 ,mr4 ,l[5?al1 ,mrs4 ,c>olyn 
,b4 ,maloney ( ,new ,york1 ,mr4         
,mc,govern1 ,mr4 ,meeks1 ,ms4 ,m5g1 ,ms4

 ,moore ( ,wiscons91 ,mr4 ,nadl]1 ,mrs4 
,napolitano1 ,ms4 ,newman1 ,ms4 ,norton1
 ,ms4 ,ocasio-,cortez1 ,ms4 ,om>1 ,mr4  
,panetta1 ,mr4 ,payne1 ,mr4 ,p]lmutt]1  
,ms4 ,p+ree1 ,mr4 ,pocan1 ,ms4          
,pressley1 ,ms4 ,roybal-,all>d1 ,mr4    
,ru%1 ,ms4 ,scanlon1 ,ms4 ,s*ak[sky1    
,mr4 ,sires1 ,mr4 ,soto1 ,ms4 ,spei]1   
,mr4 ,takano1 ,ms4 ,tlaib1 ,mrs4 ,torres
 ( ,cali=nia1 ,mr4 ,torres ( ,new ,york1
 ,mr4 ,trone1 ,mr4 ,v>gas1 ,mr4 ,veasey1
 ,mr4 ,vela1 ,ms4 ,velzquez1 ,ms4       
,wass]man ,s*ultz1 ,mrs4 ,watson        
,coleman1 ,mr4 ,wel*1 ,ms4 ,williams (  
,georgia1 & ,ms4 ,wilson ( ,florida7    
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]vices = 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
 ,families ,act ( #bjba or ! ,,heal =   
,immigrant ,families ,act ( #bjba4  #b4 
,f9d+s2 purpose  7a7 ,f9d+s ,congress   
f9ds z foll[s3 7#a7 ,heal? insurance    
cov]age r$uces h>mful racial1 economic1 
g5d]1 & heal? inequities by alleviat+   
co/ b>ri]s to1 & increas+ utilization (1
 necess>y heal? c>e s]vices1 especially 
among l[-income & und]s]v$ populations4 
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 inequities 9 ! prev5tion1       
diagnosis1 & treatm5t ( heal?           
conditions4 ,?is leads to negative heal?
 outcomes = immigrants & _! families1   
especially ,black1 ,indig5\s1 ,lat9x1   

,asian1 ,pacific ,isl&]1 & o!r          
,immigrants ( ,color4  7#d7 ,black      
immigrant wom5 (t5 cite co/ z a major   
b>ri] to heal? c>e4 ,_m :o are          
undocum5t$ =go doctor visits altoge!r   
due to ! f9ancial burd5 9 addition to   
consi/5t racial bias by m$ical          
practition]s & racism 9 heal? c>e4  7#e7
 ,ne>ly half ( immigrant wom5 are (     
reproductive age4 ,immigrant wom51      
lesbian1 gay1 bisexual1 transg5d]1 &    
que] 7,,lgbtq7 immigrants1 & immigrants 
) disabilities disproportionately live 9
 h\seholds ) l[ incomes & lack heal?    
insurance cov]age4 ,legal & policy      
b>ri]s to af=dable heal? insurance      
cov]age significantly exac]bate _! risk 
( negative pregnancy-relat$ & o!r       
reproductive & sexual heal? outcomes1 ) 
la/+ heal? & economic consequ5ces =     
immigrant wom51 ,,lgbtq immigrants1     
immigrants ) disabilities1 & _! families
 & society z a :ole4  7#f7 ,immigrants  
:o id5tify z ,,lgbtq exp]i5ce comp\nd+  
discrim9ation f heal? c>e provid]s &    

sy/ems bas$ on race & e?nicity1 prim>y  
language1 immigration /atus1 sexual     
ori5tation1 & g5d] id5tity4 ,ne>ly "o 9 
five transg5d] pati5ts h be5 refus$ c>e 
due to _! g5d] non-con=m+ /atus1 &      
provid]s h d5i$ c>e to undocum5t$       
immigrants because ( immigration /atus4 
,^! inequities are exac]bat$ by legal & 
policy b>ri]s t re/rict access to heal? 
cov]age on ! basis ( immigration /atus1 
expos+ ,,lgbtq immigrant communities to 
disproportionate gaps 9 af=dable1       
compreh5sive heal? c>e4 ,^! comp\nd+    
b>ri]s are especially h>mful = ,,lgbtq  
immigrants :o are escap+ int]p]sonal &  
/ate viol5ce due to _! sexual ori5tation
 & g5d] id5tity4  7#g7 ,d5y+ heal?      
insurance cov]age or impos+ wait+ p]iods
 = heal? insurance cov]age on ! basis ( 
immigration /atus unfairly h9d]s        
immigrants' ability to rea* & ma9ta9 _! 
optimal levels ( heal? & und]m9es !     
economic well-be+ ( _! families4  7#h7  
,int]national human rights /&>ds hold t 
gov]nm5ts h an affirmative obligation to

 ensure t ev]yone1 includ+ immigrants1 c
 access safe1 respectful1 culturally &  
l+ui/ically appropriate1 & high-quality 
pregnancy-relat$ c>e1 includ+ po/p>tum  
c>e1 free f discrim9ation or viol5ce4   
,m$icaid is ! nation's s+le l>ge/ pay] =
 pregnancy-relat$ c>e4 ,nev]!less1      
b>ri]s to heal? cov]age p]si/ = pregnant
 & po/p>tum p1 p>ticul>ly immigrants4   
7#i7 ,immigrants--especially ,black1    
,indig5\s1 ,lat9x1 ,asian1 & ,pacific   
,isl&] immigrants--are among ^? mo/ h>m$
 by ! ,unit$ ,/ates' pregnancy-relat$   
morbidity & mortality epidemic1 :i* is !
 wor/ among high-income nations4 ,black 
p are ne>ly f\r times m likely ?an :ite 
p to suff] pregnancy-relat$ dea?1 &     
twice z likely to suff] mat]nal         
morbidity4 ,indig5\s p are two & a half 
times m likely ?an :ite p to die f a    
pregnancy-relat$ dea?4 ,! majority (    
,unit$ ,/ates pregnancy-relat$ dea?s are
 prev5table4 ,lack ( access to heal?    
c>e1 immigration /atus1 pov]ty1 &       
exposure to racism1 sexism1 & x5ophobia 

9 & beyond ! heal? c>e sy/em contribute 
to ! disproportionately high numb] (    
pregnancy-relat$ dea?s among ,,bipoc    
bir?+ & po/p>tum p4 ,unnecess>y b>ri]s t
 limit pregnant & po/p>tum immigrants'  
access to heal? c>e und]m9e _! heal?1   
safety1 & human rights4  7#aj7 ,"o 9    
sev5 ,unit$ ,/ates resid5ts is          
=eign-born1 approximately "o 9 f\r      
*ildr5 9 ! ,unit$ ,/ates has at lea/ "o 
immigrant p>5t1 & ! population (        
immigrant families 9 ! ,unit$ ,/ates is 
expect$ to cont9ue to gr[ 9 ! com+ ye>s4
 ,x is !re=e 9 our collective public    
heal? & economic int]e/ to remove legal 
& policy b>ri]s to af=dable heal?       
insurance cov]age t are bas$ on         
immigration /atus4  7#aa7 ,al?\gh       
individuals grant$ relief "u ! ,def]r$  
,action = ,*ildhood ,arrivals 7,,daca7  
program are au?oriz$ to live & "w 9 !   
,unit$ ,/ates1 !y h be5 unfairly exclud$
 f ! def9itions ( lawfully pres5t &     
lawfully resid+ = purposes ( heal?      
insurance cov]age provid$ ?r\gh !       

,dep>tm5t ( ,heal? & ,human ,s]vices1   
includ+ ,m$icaid1 ,,*ip1 & ! heal?      
insurance ex*anges4  7#ab7 ,s9ce        
immigration law evolves con/antly1 new  
immigration categories = individuals )  
f$]ally au?oriz$ pres5ce 9 ! ,unit$     
,/ates may be creat$4  7#ac7 ,"s ,/ates 
cont9ue to unwisely re/rict ,m$icaid    
access = immigrants :o h long resid$ 9 !
 ,unit$ ,/ates1 fuel+ significant heal? 
inequities & increas+ heal? c>e co/s =  
individuals & ! public4  7#ad7 ,congress
 re/or$ ,m$icaid eligibility =          
individuals liv+ 9 ! ,unit$ ,/ates "u ! 
,compacts ( ,free ,association z "p (   
bip>tisan legislation 9 ,decemb] #bjbj &
 %\ld build on t success by ensur+ all  
immigrants c access c>e4  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*anges

 e/abli%$ "u "p ,,ii ( ! ,pati5t        
,protection & ,af=dable ,c>e ,act1      
,public ,law #aaa-adh2  7#c7 elim9ate ! 
au?ority = ,/ates to re/rict ,m$icaid   
eligibility = lawful p]man5t resid5ts2 &
  7#d7 elim9ate o!r b>ri]s to access+   
,m$icaid1 ,,*ip1 & o!r m$ical assi/ance4
  #c4 ,remov+ b>ri]s to heal? cov]age = 
lawfully resid+ individuals  7a7        
,m$icaid ,section #aijc7v77#d7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acif;b7v77#d77 is am5d$-- 7#a7 by am5d+
 subp>agraph 7,a7 to read z foll[s3     
7,a7 ,not)/&+ sections #dja7;a71        
#djb7;b71 #djc1 & #dba ( ! ,p]sonal     
,responsibility & ,"w ,opportunity      
,reconciliation ,act ( #aiif1 a ,/ate   
%all provide m$ical assi/ance "u ?is    
title1 to individuals :o are lawfully   
resid+ 9 ! ,unit$ ,/ates 7includ+       
individuals describ$ 9 p>agraph 7#a71   
batt]$ individuals describ$ 9 section   
#dca7;c7 ( su* ,act1 & individuals ) an 
approv$ or p5d+ application = def]r$    
action or o!r f$]ally au?oriz$ pres5ce71

 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 paym5t74  2  7#b7
 by am5d+ subp>agraph 7,b7 to read z    
foll[s3  7,b7 ,no debt %all accrue "u an
 affidavit ( support aga9/ any sponsor (
 an individual provid$ m$ical assi/ance 
"u subp>agraph 7,a7 on ! basis (        
provision ( assi/ance to su* individual 
& ! co/ ( su* assi/ance %all n be       
consid]$ z an unreimburs$ co/4  2 &     
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 #adaa ( ! ,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 by am5d+ clause 7ii7 to read z     
foll[s3  7ii7 ! taxpay] is a noncitiz5  

:o is n eligible = ! ,m$icaid program "u
 title ,,xix ( ! ,social ,security ,act 
by reason ( ! individual's immigration  
/atus1  4  7,b7 by /rik+ subsection 7e74
  7#b7 ,co/-%>+ r$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 #bjba4  #f4  
,pres]v+ access to cov]age  7a7 ,9 g5]al
 ,no?+ 9 ?is ,act1 includ+ ! am5dm5ts   
made by ?is ,act1 %all prev5t lawfully  
pres5t noncitiz5s :o are ineligible =   
full b5efits "u ! ,m$icaid program "u   
title ,,xix ( ! ,social ,security ,act f
 secur+ a cr$it = :i* su* lawfully      

pres5t noncitiz5s w\ld be eligible "u   
section #cf;,b7c77#a77;,b7 ( ! ,int]nal 
,rev5ue ,code ( #aihf & "u ! ,m$icaid   
provisions = lawfully pres5t noncitiz5s1
 z 9 effect on ! date prior to ! date ( 
enactm5t ( ?is ,act4  7b7 ,def9ition ,= 
purposes ( subsection 7a71 ! t]m full   
b5efits means1 ) respect to an          
individual & ,/ate1 m$ical assi/ance =  
all s]vices cov]$ "u ! ,/ate plan "u    
title ,,xix ( ! ,social ,security ,act t
 is n less 9 am\nt1 duration1 or scope1 
or is det]m9$ by ! ,secret>y ( ,heal? & 
,human ,s]vices to be sub/antially      
equival5t to ! m$ical assi/ance         
available = an individual describ$ 9    
section #aijb7;a77#aj77;,a77i7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acif;a7a77#aj77;,a77i774