I 

113TH CONGRESS 

2D SESSION H. R. 4240 

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

and maternal health services, for immigrant women, men, and families 

by removing legal barriers to health insurance coverage, and for other 

purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 13, 2014 

Ms. MICHELLE LUJAN GRISHAM of New Mexico (for herself, Ms. LEE of California, Ms. NORTON, Mrs. CHRISTENSEN, Ms. FUDGE, Mr. GUTIE ́RREZ, 

Ms. ROYBAL-ALLARD, Mr. VEASEY, Mr. CA ́RDENAS, Mr. GRIJALVA, Ms. 

BROWN of Florida, Mr. HASTINGS of Florida, Ms. LINDA T. SA ́NCHEZ

of California, Ms. PINGREE of Maine, Ms. SCHAKOWSKY, Mr. VARGAS, 

and Mrs. NAPOLITANO) 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 immigrant 

women, men, and families by removing legal 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 2014’’ or as the ‘‘HEAL Immigrant Women and 

5 Families Act of 2014’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds as follows: 

8 (1) Insurance coverage reduces harmful health 

9 disparities by alleviating cost barriers to and in10 creasing utilization of basic preventive health serv11 ices, especially among low-income and underserved 

12 populations, and especially among women. 

13 (2) Based solely on their immigration status, 

14 many immigrants and their families face legal re15 strictions on their ability to obtain health insurance 

16 coverage through Medicaid, CHIP, and Health In17 surance Exchanges. 

18 (3) Lack of health insurance contributes to per19 sistent disparities in the prevention, diagnosis, and 

20 treatment of negative health outcomes borne by im21 migrants and their families. 

22 (4) Immigrant women are disproportionately of 

23 reproductive age, low-income, and lacking health in24 surance coverage. Legal barriers to affordable health 

25 insurance coverage therefore particularly exacerbate 

26 their risk of negative sexual, reproductive, and mamstockstill on DSK4VPTVN1PROD with BILLS

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1 ternal health outcomes, with lasting health and eco2 nomic consequences for immigrant women, their 

3 families, and society as a whole. 

4 (5) Denying coverage or imposing waiting peri5 ods for coverage unfairly hinders the ability of immi6 grants to take responsibility for their own health 

7 and economic well-being and that of their families. 

8 To fully and productively participate in society, ac9 cess to health care is fundamental, which for women 

10 includes access to the services necessary to plan 

11 whether and when to have a child. 

12 (6) The population of immigrant families in the 

13 United States is expected to continue to grow. In14 deed one in five children in the United States is part 

15 of an immigrant family. It is therefore in the na16 tion’s shared public health and economic interest to 

17 remove legal barriers to affordable health insurance 

18 coverage based on immigration status. 

19 SEC. 3. REMOVING BARRIERS TO HEALTH COVERAGE FOR 

20 LAWFULLY PRESENT INDIVIDUALS. 

21 (a) MEDICAID.—Section 1903(v)(4) of the Social Se22 curity Act (42 U.S.C. 1396b(v)(4)) is amended— 

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

24 follows: 

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

2 and 421 of the Personal Responsibility and Work Oppor3 tunity Reconciliation Act of 1996, payment shall be made 

4 under this section for care and services that are furnished 

5 to aliens, including those described in paragraph (1), if 

6 they otherwise meet the eligibility requirements for med7 ical assistance under the State plan approved under this 

8 title (other than the requirement of the receipt of aid or 

9 assistance under title IV, supplemental security income 

10 benefits under title XVI, or a State supplementary pay11 ment), and are lawfully present in the United States.’’; 

12 (2) in subparagraph (B)— 

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

14 provide medical assistance to a category of 

15 aliens under subparagraph (A)’’ and inserting 

16 ‘‘aliens provided medical assistance pursuant to 

17 subparagraph (A)’’; and 

18 (B) by striking ‘‘to such category’’ and in19 serting ‘‘to such alien’’; 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 (J) 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 ‘‘(J) 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 the enactment of this 

12 Act and shall apply to services furnished on or after 

13 the date that is 90 days after such date of the enact14 ment. 

15 (2) EXCEPTION IF STATE LEGISLATION RE16 QUIRED.—In the case of a State plan for medical as17 sistance under title XIX, or a State child health plan 

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

19 Secretary of Health and Human Services determines 

20 requires State legislation (other than legislation ap21 propriating funds) in order for the plan to meet the 

22 additional requirements imposed by the amendments 

23 made by this section, the respective State plan shall 

24 not be regarded as failing to comply with the re25 quirements of such title solely on the basis of its 

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1 failure to meet these additional requirements before 

2 the first day of the first calendar quarter beginning 

3 after the close of the first regular session of the 

4 State legislature that begins after the date of the en5 actment of this Act. For purposes of the previous 

6 sentence, in the case of a State that has a 2-year 

7 legislative session, each year of such session shall be 

8 deemed to be a separate regular session of the State 

9 legislature. 

10 SEC. 4. REMOVING BARRIERS TO HEALTH COVERAGE FOR 

11 INDIVIDUALS GRANTED DEFERRED ACTION 

12 FOR CHILDHOOD ARRIVALS. 

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

14 under any of the provisions referred to in subsection (b), 

15 individuals granted deferred action under the Deferred Ac16 tion for Childhood Arrivals process of the Department of 

17 Homeland Security, as described in the memorandum of 

18 the Secretary of Homeland Security on June 15, 2012, 

19 shall be considered lawfully present in the United States. 

20 (b) PROVISIONS DESCRIBED.—The provisions de21 scribed in this subsection are the following: 

22 (1) EXCHANGE ELIGIBILITY.—Section 1311 of 

23 the Patient Protection and Affordable Care Act (42 

24 U.S.C. 18031). 

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1 (2) REDUCED COST-SHARING ELIGIBILITY.— 

2 Section 1402 of the Patient Protection and Afford3 able Care Act (42 U.S.C. 18071). 

4 (3) PREMIUM SUBSIDY ELIGIBILITY.—Section 

5 36B of the Internal Revenue Code of 1986. 

6 (4) MEDICAID AND CHIP ELIGIBILITY.—Titles 

7 XIX and XXI of the Social Security Act, including 

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

9 1396b(v)). 

10 (c) EFFECTIVE DATE.— 

11 (1) IN GENERAL.—Subsection (a) shall take ef12 fect on the date of the enactment of this Act. 

13 (2) TRANSITION THROUGH SPECIAL ENROLL14 MENT PERIOD.—In the case of an individual de15 scribed in subsection (a) who, before the first day of 

16 the first annual open enrollment period under sub17 paragraph (B) of section 1311(c)(6) of the Patient 

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

19 18031(c)(6)) beginning after the date of the enact20 ment of this Act, is granted deferred action de21 scribed in subsection (a) and who, as a result of 

22 such subsection, qualifies for a subsidy described in 

23 paragraph (2) or (3) of such subsection, the Sec24 retary of Health and Human Services shall establish 

25 a special enrollment period under section 

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1 1311(c)(6)(C) of such Act during which such indi2 vidual may enroll in qualified health plans through 

3 Exchanges under title I of such Act and qualify for 

4 such a subsidy. For such an individual who has been 

5 granted deferred action as of the date of the enact6 ment of this Act, such special enrollment period 

7 shall begin not later than 90 days after such date 

8 of enactment. Nothing in this paragraph shall be 

9 construed as affecting the authority of the Secretary 

10 to establish additional special enrollment periods 

11 under section 1311(c)(6)(C) of the Patient Protec12 tion and Affordable Care Act (42 U.S.C. 

13 18031(c)(6)(C)). 

Æ 

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