Claims suggesting the Biden administration is forcing states to fund health care costs for ‘illegal’ immigrants are misleading

On Aug. 15, conservative columnist Miranda Devine claimed in an X post that the Biden-Harris administration will impose a new rule on Nov. 1 that will force states to fund health care for “illegal aliens.”

A day after the post went viral, conservative news outlet The Gateway Pundit published an article citing Devine’s claim with the headline: “WICKED: Joe Biden and Kamala Harris Force States to Fund Health Care Costs for Illegal Aliens Starting Nov. 1, 2024 — As Average U.S. Family Pays $23,968 per Year!” The Gateway Pundit posted the same claim on X.

A VERIFY reader sent us a text asking whether these claims are true.

THE QUESTION

Is the Biden administration forcing states to fund health care costs for “illegal” immigrants starting Nov. 1?

THE SOURCES

• U.S. Department of Health and Human Services
• Centers for Medicare & Medicaid Services 
• Healthcare.gov
• KFF, a nonprofit health policy research organization formerly known as The Kaiser Family Foundation
• National Immigration Forum, an immigrant advocacy nonprofit group

THE ANSWER

Claims suggesting the Biden administration is forcing states to fund health care costs for “illegal” immigrants starting Nov. 1 are misleading.

The Biden administration finalized a rule in May to expand access to health care coverage for DACA recipients through the Affordable Care Act’s Health Insurance Marketplace, but the rule does not apply to all undocumented immigrants in the U.S.

WHAT WE FOUND

There are around 21.2 million noncitizen immigrants residing in the United States. Among noncitizen immigrants, about six in 10 are lawfully present immigrants while the remaining four in 10 are undocumented immigrants, according to health policy research nonprofit KFF.

Healthcare.gov says the term “lawfully present” is used to describe immigrants who have:

• “Qualified non-citizen” immigration status without a waiting period, such as refugees or asylees
• Humanitarian statuses or circumstances (including Temporary Protected Status, Special Juvenile Status, asylum applicants, Convention Against Torture, victims of trafficking)
• Valid non-immigrant visas, such as work or school visas
• Legal status conferred by other laws (temporary resident status, LIFE Act, Family Unity individuals)

Lawfully present immigrants can receive health care coverage through the federal government’s Affordable Care Act (ACA) Health Insurance Marketplace. But undocumented immigrants are not eligible to get coverage through the marketplace.

The claims suggesting the Biden administration is forcing states to fund health care costs for “illegal” immigrants are referring to a rule finalized on May 3 by the U.S. Department of Health and Human Services (HHS) through the Centers for Medicare & Medicaid Services (CMS).

The rule, which goes into effect on Nov. 1, modifies the definition of lawfully present in order to expand access to health care coverage for Deferred Action for Childhood Arrivals (DACA) recipients.

The DACA program was established through executive action in 2012 during the Obama administration to protect eligible undocumented immigrants who were brought to the U.S. as children from deportation and to provide them with work authorization for temporary, renewable periods, according to KFF and the National Immigration Forum. As of Dec. 31, 2023, there were roughly 530,000 active DACA recipients from close to 200 different countries residing in the U.S.

“While individuals with DACA status can be authorized to work, they remain ineligible for many federal programs, including health coverage through Medicaid, the Children’s Health Insurance Program (CHIP), and the Affordable Care Act (ACA) Health Insurance Marketplaces,” KFF says on its website. “These restrictions result in higher uninsured rates among DACA recipients, contributing to barriers accessing health care.”

The Biden administration’s new rule will ensure that DACA recipients will no longer be excluded from enrollment in a qualified health plan (QHP) through the ACA’s Health Insurance Marketplace or for coverage through a basic health program (BHP). That’s because DACA recipients will now be considered lawfully present and be eligible to apply for health coverage through the ACA’s marketplace starting on Nov. 1.

CMS estimates that the rule could lead to 100,000 previously uninsured DACA recipients newly enrolling in health coverage through a marketplace plan or a BHP.

As a result of the rule, DACA recipients will qualify for a special enrollment period to select a health plan through the marketplace during the 60 days following the rule’s Nov. 1 effective date. This timing corresponds with the 2025 Open Enrollment Period. DACA recipients who apply in November can have their coverage begin as early as Dec. 1, 2024, if they meet all other eligibility requirements, according to HHS.

In August, the attorneys general in 15 states, including Alabama, Idaho, Indiana, Iowa, Kansas, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, South Carolina, South Dakota, Tennessee and Virginia, filed a lawsuit against the Biden administration over the rule, which they claim is “treating illegal aliens as legal citizens and making states pay for their public benefits.”

There has been increased state action to expand health care coverage to immigrants in recent years, according to KFF. As of June 2024, 12 states and Washington, D.C. provide fully state-funded coverage for income-eligible children regardless of immigration status and six states plus Washington, D.C. provide fully state-funded coverage to some income-eligible adults regardless of status, KFF says.

“Despite these expansions, uninsured rates remain high among noncitizen immigrants, with 18% of lawfully present immigrant adults and half of likely undocumented immigrant adults reporting being uninsured,” KFF said.