,,ii  #aai? ,,congress  #a/ ,session    
,s4 #badi  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,june #bd1 #bjbe ,mr4  
,book] 7= himself1 ,mr4 ,he9ri*1 ,mr4   
,padilla1 ,ms4 ,w>r51 ,mrs4 ,murray1    
,ms4 ,hirono1 ,mr4 ,s&]s1 ,mr4          
,blum5?al1 & ,mr4 ,m>key7 introduc$ !   
foll[+ bill2 :i* 0 read twice & ref]r$  
to ! ,committee on ,f9ance  ,a ,,bill   
,to exp& access to heal? insurance      
cov]age = immigrants & _! families 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 ( #bjbe4  #b4
  ,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,p7 ( section             
#bajg7;e77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acig;gg7e77#a77 is     
am5d$ to read z foll[s3  7,p7 ,p>agraph 

7#d7 ( section #aijc7v7 7relat+ to      
lawfully pres5t individuals & undocum5t$
 immigrants74  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$icaid 
program "u title ,,xix ( ! ,social      
,security ,act by reason ( !            
individual's immigration /atus1  2 &    
7,b7 by /rik+ subsection 7e74  7#b7     
,co/-%>+ r$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   
#bjbe4  #f4  ,/ate option to exp&       
,m$icaid & ,,*ip to individuals )\t     
lawful pres5ce  7a7  ,m$icaid  7#a7  ,9 
g5]al  ,section #aijb7;a77#aj77;,a77ii7 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acif;a7a77#aj77;,a77ii77 is  
am5d$--  7,a7 9 subclause 7,,xxii71 by  

/rik+ or at ! end2  7,b7 9 subclause    
7,,xxiii71 by /rik+ ! semicolon & ins]t+
 2 or2 &  7,c7 by add+ at ! end ! foll[+
 new subclause3  7,,xxiv7 :o w\ld be    
eligible "u ! ,/ate plan 7or waiv] ( su*
 plan7 "u ?is title if !y 7 citiz5s ( ! 
,unit$ ,/ates2  4  7#b7  ,con=m+ am5dm5t
  ,section #aije7;a7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#acif;d7a77 is am5d$1 9 ! matt] prec$+  
p>agraph 7#a7--  7,a7 9 ! matt]         
designat$ z clause 7xvi71 by /rik+ or at
 ! end2  7,b7 9 ! matt] designat$ z     
clause 7xvii71 by add+ or at ! end2 &   
7,c7 by ins]t+ aft] ! matt] designat$ z 
clause 7xvii7 ! foll[+3  7xviii7        
individuals describ$ 9 section          
#aijb7;a77#aj77;,a77ii77,,xxiv71  4  7b7
  ,,*ip  ,title ,,xxi ( ! ,social       
,security ,act 7#db ,u4,s4,c4 #acig;aa  
et seq47 is am5d$ by ins]t+ aft] section
 #baab ! foll[+ new section3  #baab;,a4 
,/ate option to provide cov]age =       
individuals )\t lawful pres5ce  ,a ,/ate
 may elect ?r\gh an am5dm5t to its ,/ate

 *ild heal? plan "u section #bajb to    
treat an individual z a t>get$ l[-income
 *ild or a t>get$ l[-income pregnant    
woman = purposes ( ?is title if su*     
individual w\ld o!rwise be includ$ z su*
 a *ild or su* a pregnant woman 7z      
applicable7 "u su* plan if ! individual 
7 a citiz5 ( ! ,unit$ ,/ates4  4  7c7   
,nonapplication ( eligibility           
prohibition  ,section #dja7;a7 ( !      
,p]sonal ,responsibility & ,"w          
,opportunity ,reconciliation ,act (     
#aiif 7#db ,u4,s4,c4 #afaa7;a77 is am5d$
 by add+ at ! end ! foll[+ new s5t5ce3  
,! prec$+ s5t5ce %all n apply ) respect 
to a noncitiz5's eligibility "u a ,/ate 
plan 7or waiv] ( su* plan7 "u title     
,,xix ( ! ,social ,security ,act or "u a
 ,/ate *ild heal? plan 7or waiv] ( su*  
plan7 "u title ,,xxi ( su* ,act to !    
ext5t t su* ,/ate has elect$ to make su*
 individual s eligible pursuant to      
section #aijb7;a77#aj77;,a77ii77,,xxiv7 
or #baab;,a ( su* ,act1 respectively44  
#g4  ,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  #h4  ,remov+ 
b>ri]s to heal? cov]age = lawfully      
pres5t individuals 9 ,m$ic>e  7a7  ,"p  
,a  ,section #ahah7;a77#c7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#acie;i-#b7;a77#c77 is am5d$ by /rik+ an
 ali5 & all t foll[s ?r\gh "u ?is       
section & ins]t+ an individual :o is    
lawfully pres5t 7z def9$ 9 section      
#h7;c7 ( ! ,heal? ,equity & ,access "u !
 ,law = ,immigrant ,families ,act (     
#bjbe7 9 ! ,unit$ ,/ates1 includ+ an    
individual ) an approv$ or p5d+         
application = def]r$ action or o!r      
,f$]ally au?oriz$ pres5ce4  7b7  ,"p ,b 
,section #ahcf7;a77#b7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acieo7a77#b77 is am5d$ by /rik+ an ali5
 & all t foll[s ?r\gh "u ?is "p & ins]t+
 an individual :o is lawfully pres5t 7z 
def9$ 9 section #h7;c7 ( ! ,heal?       
,equity & ,access "u ! ,law = ,immigrant
 ,families ,act ( #bjbe7 9 ! ,unit$     
,/ates1 includ+ an individual ) an      
approv$ or p5d+ application = def]r$    

action or o!r ,f$]ally au?oriz$ pres5ce4
  7c7  ,lawfully pres5t def9$  ,! t]m   
lawfully pres5t %all include1 at a      
m9imum1 all immigration categories t are
 treat$ z lawfully pres5t = purposes ( !
 title ,,xix program z am5d$ by section 
#c4