I 

116TH CONGRESS 

1ST SESSION H. R. 4701 

To expand access to health care services, including sexual, reproductive, 

and maternal health services, for immigrants by removing legal and 

policy barriers to health insurance coverage, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 16, 2019 

Ms. JAYAPAL (for herself, Ms. HAALAND, Ms. BARRAGA ́N, Mr. BLUMENAUER, 

Ms. JUDY CHU of California, Mr. ESPAILLAT, Mr. GALLEGO, Ms. LEE

of California, Ms. MOORE, Mrs. NAPOLITANO, Ms. NORTON, Mr. POCAN, 

Ms. PRESSLEY, Ms. SCHAKOWSKY, Mr. SOTO, Ms. WILSON of Florida, 

Mr. TAKANO, Mrs. LAWRENCE, Ms. GARCIA of Texas, Mr. JOHNSON of 

Georgia, Ms. MENG, Ms. ROYBAL-ALLARD, and Mr. GRIJALVA) introduced the following bill; which was referred to the Committee on Energy 

and Commerce, and in addition to the Committee on Ways and Means, 

for a period to be subsequently determined by the Speaker, 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, including sexual, 

reproductive, and maternal health services, for immigrants by removing legal and policy barriers to health 

insurance coverage, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Health Equity and 

3 Access under the Law for Immigrant Women and Families 

4 Act of 2019’’ or as the ‘‘HEAL for Immigrant Women 

5 and Families Act of 2019’’. 

6 SEC. 2. FINDINGS; PURPOSE. 

7 (a) FINDINGS.—Congress finds as follows: 

8 (1) Health insurance coverage reduces harmful 

9 disparities by alleviating cost barriers to and in10 creasing utilization of necessary health care services, 

11 especially among low-income and underserved popu12 lations, including women. 

13 (2) Based solely on their immigration status, 

14 many immigrants and their families face legal and 

15 policy restrictions on their ability to obtain afford16 able health insurance coverage through Medicaid, 

17 the Children’s Health Insurance Program (CHIP), 

18 and the health insurance exchanges. 

19 (3) Lack of health insurance coverage contrib20 utes to persistent disparities in the prevention, diag21 nosis, and treatment of negative health outcomes ex22 perienced by immigrants and their families. 

23 (4) Nearly half of immigrant women are of re24 productive age. Immigrant women are also dis25 proportionately living in low-income households and 

26 lacking health insurance coverage. Legal and policy 


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1 barriers to affordable health insurance coverage 

2 therefore particularly exacerbate their risk of nega3 tive sexual, reproductive, and maternal health out4 comes, with lasting health and economic con5 sequences for immigrant women, their families, and 

6 society as a whole. 

7 (5) Denying health insurance coverage or im8 posing waiting periods for health insurance coverage 

9 unfairly hinders the ability of immigrants to attain 

10 good health and undermines the economic well-being 

11 of their families. 

12 (6) The population of immigrant families in the 

13 United States is expected to continue to grow. One 

14 in seven United States residents is foreign-born, and 

15 approximately one in four children in the United 

16 States has at least one immigrant parent. It is 

17 therefore in the Nation’s shared public health and 

18 economic interest to remove legal and policy barriers 

19 to affordable health insurance coverage based on im20 migration status. 

21 (7) Although Deferred Action for Childhood Ar22 rivals (DACA) recipients are authorized to live and 

23 work in the United States, they have been unfairly 

24 excluded from the definition of lawfully present and 

25 lawfully residing for purposes of health insurance 


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1 coverage through the Department of Health and 

2 Human Services, including Medicaid and CHIP, and 

3 the health insurance exchanges. 

4 (8) Immigration law is constantly evolving and 

5 new immigration categories for individuals with fed6 erally authorized presence in the United States may 

7 be created. 

8 (b) PURPOSE.—It is the purpose of this Act to— 

9 (1) ensure that all individuals who are lawfully 

10 present in the United States are eligible for all fed11 erally funded health care programs; and 

12 (2) advance the ability of undocumented indi13 viduals to obtain health insurance coverage through 

14 the health insurance exchanges. 

15 SEC. 3. REMOVING BARRIERS TO HEALTH COVERAGE FOR 

16 LAWFULLY PRESENT INDIVIDUALS. 

17 (a) MEDICAID.—Section 1903(v)(4) of the Social Se18 curity Act (42 U.S.C. 1396b(v)(4)) is amended— 

19 (1) by amending subparagraph (A) to read as 

20 follows: 

21 ‘‘(A) Notwithstanding sections 401(a), 402(b), 403, 

22 and 421 of the Personal Responsibility and Work Oppor23 tunity Reconciliation Act of 1996, payment shall be made 

24 under this section for care and services that are furnished 

25 to individuals who are not citizens of the United States, 


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1 including aliens described in paragraph (1), if they other2 wise meet the eligibility requirements for medical assist3 ance under the State plan approved under this title (other 

4 than the requirement of the receipt of aid or assistance 

5 under title IV, supplemental security income benefits 

6 under title XVI, or a State supplementary payment) and 

7 are lawfully present in the United States (including such 

8 an individual who is granted deferred action or other fed9 erally authorized presence).’’; 

10 (2) in subparagraph (B)— 

11 (A) by striking ‘‘a State that has elected to 

12 provide medical assistance to a category of 

13 aliens under subparagraph (A)’’ and inserting 

14 ‘‘individuals provided medical assistance pursu15 ant to subparagraph (A)’’; and 

16 (B) by striking ‘‘such an alien on the basis 

17 of provision of assistance to such category’’ and 

18 inserting ‘‘such an individual on the basis of 

19 provision of assistance to such individual’’; and 

20 (3) in subparagraph (C)— 

21 (A) by striking ‘‘an election by the State 

22 under subparagraph (A)’’ and inserting ‘‘the 

23 application of subparagraph (A)’’; 

24 (B) by inserting ‘‘or be lawfully present’’ 

25 after ‘‘lawfully reside’’; and 


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1 (C) by inserting ‘‘or present’’ after ‘‘law2 fully residing’’ each place it appears. 

3 (b) CHIP.—Subparagraph (N) of section 2107(e)(1) 

4 of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 

5 amended to read as follows: 

6 ‘‘(N) Paragraph (4) of section 1903(v) (re7 lating to lawfully present individuals).’’. 

8 (c) EFFECTIVE DATE.— 

9 (1) IN GENERAL.—Except as provided in para10 graph (2), the amendments made by this section 

11 shall take effect on the date of enactment of this Act 

12 and shall apply to services furnished on or after the 

13 date that is 90 days after such date of enactment. 

14 (2) EXCEPTION IF STATE LEGISLATION RE15 QUIRED.—In the case of a State plan for medical as16 sistance under title XIX, or a State child health plan 

17 under title XXI, of the Social Security Act which the 

18 Secretary of Health and Human Services determines 

19 requires State legislation (other than legislation ap20 propriating funds) in order for the plan to meet the 

21 additional requirements imposed by the amendments 

22 made by this section, the respective State plan shall 

23 not be regarded as failing to comply with the re24 quirements of such title solely on the basis of its 

25 failure to meet these additional requirements before 


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1 the first day of the first calendar quarter beginning 

2 after the close of the first regular session of the 

3 State legislature that begins after the date of enact4 ment of this Act. For purposes of the previous sen5 tence, in the case of a State that has a 2-year legis6 lative session, each year of such session shall be 

7 deemed to be a separate regular session of the State 

8 legislature. 

9 SEC. 4. CONSISTENCY IN HEALTH INSURANCE COVERAGE 

10 FOR INDIVIDUALS WITH FEDERALLY AU11 THORIZED PRESENCE, INCLUDING DE12 FERRED ACTION. 

13 (a) IN GENERAL.—For purposes of eligibility under 

14 any of the provisions described in subsection (b), all indi15 viduals granted federally authorized presence in the 

16 United States shall be considered to be lawfully present 

17 in the United States. 

18 (b) PROVISIONS DESCRIBED.—The provisions de19 scribed in this subsection are the following: 

20 (1) EXCHANGE ELIGIBILITY.—Section 1311 of 

21 the Patient Protection and Affordable Care Act (42 

22 U.S.C. 18031). 

23 (2) REDUCED COST-SHARING ELIGIBILITY.— 

24 Section 1402 of the Patient Protection and Afford25 able Care Act (42 U.S.C. 18071). 


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1 (3) PREMIUM SUBSIDY ELIGIBILITY.—Section 

2 36B of the Internal Revenue Code of 1986 (26 

3 U.S.C. 36B). 

4 (4) MEDICAID AND CHIP ELIGIBILITY.—Titles 

5 XIX and XXI of the Social Security Act, including 

6 under section 1903(v) of such Act (42 U.S.C. 

7 1396b(v)). 

8 (c) EFFECTIVE DATE.— 

9 (1) IN GENERAL.—Subsection (a) shall take ef10 fect on the date of enactment of this Act. 

11 (2) TRANSITION THROUGH SPECIAL ENROLL12 MENT PERIOD.—In the case of an individual de13 scribed in subsection (a) who, before the first day of 

14 the first annual open enrollment period under sub15 paragraph (B) of section 1311(c)(6) of the Patient 

16 Protection and Affordable Care Act (42 U.S.C. 

17 18031(c)(6)) beginning after the date of enactment 

18 of this Act, is granted federally authorized presence 

19 in the United States and who, as a result of such 

20 subsection, qualifies for a subsidy under a provision 

21 described in paragraph (2) or (3) of subsection (b), 

22 the Secretary of Health and Human Services shall 

23 establish a special enrollment period under subpara24 graph (C) of such section 1311(c)(6) during which 

25 such individual may enroll in qualified health plans 


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1 through Exchanges under title I of the Patient Pro2 tection and Affordable Care Act and qualify for such 

3 a subsidy. For such an individual who has been 

4 granted federally authorized presence in the United 

5 States as of the date of enactment of this Act, such 

6 special enrollment period shall begin not later than 

7 90 days after such date of enactment. Nothing in 

8 this paragraph shall be construed as affecting the 

9 authority of the Secretary to establish additional 

10 special enrollment periods under such subparagraph 

11 (C). 

12 SEC. 5. REMOVING CITIZENSHIP AND IMMIGRATION BAR13 RIERS TO ACCESS TO AFFORDABLE HEALTH 

14 CARE UNDER THE ACA. 

15 (a) IN GENERAL.— 

16 (1) PREMIUM TAX CREDITS.—Section 36B of 

17 the Internal Revenue Code of 1986 is amended— 

18 (A) in subsection (c)(1)(B)— 

19 (i) by amending the heading to read 

20 as follows: ‘‘SPECIAL RULE FOR CERTAIN

21 INDIVIDUALS INELIGIBLE FOR MEDICAID

22 DUE TO STATUS’’; and 

23 (ii) in clause (ii), by striking ‘‘lawfully 

24 present in the United States, but’’ and in25 serting ‘‘who’’; and 


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1 (B) by striking subsection (e). 

2 (2) COST-SHARING REDUCTIONS.—Section 1402 

3 of the Patient Protection and Affordable Care Act 

4 (42 U.S.C. 18071) is amended by striking sub5 section (e) and redesignating subsection (f) as sub6 section (e). 

7 (3) BASIC HEALTH PROGRAM ELIGIBILITY.— 

8 Section 1331(e)(1)(B) of the Patient Protection and 

9 Affordable Care Act (42 U.S.C. 18051(e)(1)(B)) is 

10 amended by striking ‘‘lawfully present in the United 

11 States,’’. 

12 (4) RESTRICTIONS ON FEDERAL PAYMENTS.— 

13 Section 1412 of the Patient Protection and Afford14 able Care Act (42 U.S.C. 18082) is amended by 

15 striking subsection (d) and redesignating subsection 

16 (e) as subsection (d). 

17 (5) REQUIREMENT TO MAINTAIN MINIMUM ES18 SENTIAL COVERAGE.—Subsection (d) of section 

19 5000A of the Internal Revenue Code of 1986 is 

20 amended by striking paragraph (3) and by redesig21 nating paragraph (4) as paragraph (3). 

22 (b) CONFORMING AMENDMENTS.— 

23 (1) ESTABLISHMENT OF PROGRAM.—Section 

24 1411(a) of the Patient Protection and Affordable 

25 Care Act (42 U.S.C. 18081(a)) is amended by strikVerDate Sep 11 2014 04:09 Oct 23, 2019 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H4701.IH H4701

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1 ing paragraph (1) and redesignating paragraphs (2), 

2 (3), and (4) as paragraphs (1), (2), and (3), respec3 tively. 

4 (2) QUALIFIED INDIVIDUALS.—Section 1312(f) 

5 of the Patient Protection and Affordable Care Act 

6 (42 U.S.C. 18032(f)) is amended— 

7 (A) in the heading, by striking ‘‘; ACCESS

8 LIMITED TO CITIZENS AND LAWFUL RESI9 DENTS’’; and 

10 (B) by striking paragraph (3). 

11 (c) EFFECTIVE DATE.—The amendments made by 

12 this section shall apply to years, plan years, and taxable 

13 years, as applicable, beginning after December 31, 2020. 

Æ 


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