DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland   21244-1850 
 
Center for Medicaid and CHIP Services 
 
         
  SHO# 12-002 
 
August 28, 2012 
 
Re:  Individuals with Deferred Action 
for Childhood Arrivals 
 
Dear State Health Official: 
Dear Medicaid Director: 
 
This guidance is intended to inform you about the implications for Medicaid and the Childrens 
Health Insurance Program (CHIP) of the U.S. Department of Homeland Securitys (DHS) 
announcement on June 15, 2012, that it will consider providing temporary relief from removal by 
exercising deferred action on a case-by-case basis with respect to certain individuals under age 31 as 
of June 15, 2012 who meet certain guidelines, including that they came to the United States as 
children and do not present a risk to national security or public safety.1  This process is referred to by 
DHS as Deferred Action for Childhood Arrivals (DACA).2  DHS has explained that the DACA 
process is designed to ensure that governmental resources for the removal of individuals are focused 
on high priority cases, including those involving a danger to national security or a risk to public 
safety, and not on low priority cases.3  DHS began accepting requests for consideration of deferred 
action on August 15, 2012. 
 
Section 214 of the Childrens Health Insurance Program Reauthorization Act of 2009 (CHIPRA) 
gave states the option to provide Medicaid and CHIP eligibility to children and/or pregnant women 
who are lawfully residing in the United States and otherwise eligible for Medicaid or CHIP.  CMS 
provided guidance on the definition of lawfully residing in a July 1, 2010 State Health Official 
Letter (http://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/SHO10006.pdf). 
Because the reasons that DHS offered for adopting the DACA process do not pertain to eligibility for 
Medicaid or CHIP, HHS has determined that these benefits should not be extended as a result of DHS 
deferring action under DACA.  For this reason, individuals with deferred action under the DACA 
process shall not be eligible for Medicaid and CHIP under the CHIPRA state option with respect to 
any of the categories (1)-(9) set forth in the July 1, 2010 letter. 
 
                                                 
1 June 15, 2012 Memorandum of Secretary of Homeland Security Janet Napolitano, available at 
http://www.dhs.gov/xlibrary/assets/s1-exercising-prosecutorial-discretion-individuals-who-came-to-us-as-children.pdf. 
2 Consideration of Deferred Action for Childhood Arrivals, available at http://www.uscis.gov/childhoodarrivals. 
3 See supra nn. 1-2.  Page 2   State Health Official 
  State Medicaid Director 
 
We hope this information will be helpful.  Thank you for your commitment to the Medicaid and 
CHIP programs. 
 
                Sincerely, 
 
                /s/ 
 
                Cindy Mann 
                Director 
 
cc:   
 
CMS Regional Administrators 
  
CMS Associate Regional Administrators  
Division of Medicaid and Childrens Health Operations 
 
Matt Salo  
Executive Director  
National Association of Medicaid Directors  
 
Alan R. Weil, J.D., M.P.P.  
Executive Director  
National Academy for State Health Policy  
 
Ronald Smith  
Director of Legislative Affairs  
American Public Human Services Association  
 
Joy Wilson  
Director, Health Committee  
National Conference of State Legislatures  
 
Heather Hogsett  
Director of Health Legislation  
National Governors Association  
 
Debra Miller  
Director for Health Policy  
Council of State Governments  
 
Christopher Gould  
Director, Government Relations  
Association of State and Territorial Health Officials