I 

117TH CONGRESS 

1ST SESSION H. R. 3149 

To expand access to health care services for immigrants by removing legal 

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

IN THE HOUSE OF REPRESENTATIVES 

MAY 12, 2021 

Ms. JAYAPAL (for herself, Ms. BARRAGA ́N, Ms. ADAMS, Mr. AUCHINCLOSS, 

Ms. BASS, Mr. BEYER, Mr. BLUMENAUER, Ms. BONAMICI, Mr. BOWMAN, 

Ms. BUSH, Mr. CA ́RDENAS, Mr. CARSON, Mr. CASTRO of Texas, Ms. 

CHU, Mr. CICILLINE, Ms. CLARK of Massachusetts, Ms. CLARKE of New 

York, Mr. COHEN, Mr. CONNOLLY, Mr. CORREA, Mr. DANNY K. DAVIS

of Illinois, Mr. DESAULNIER, Mr. DEUTCH, Ms. ESCOBAR, Mr. 

ESPAILLAT, Mr. GALLEGO, Mr. GARCI ́A of Illinois, Ms. GARCIA of Texas, 

Mr. GOMEZ, Mr. GREEN of Texas, Mr. GRIJALVA, Mrs. HAYES, Ms. 

JACKSON LEE, Ms. JACOBS of California, Mr. JOHNSON of Georgia, Mr. 

JONES, Mr. KEATING, Mrs. LAWRENCE, Ms. LEE of California, Ms. 

LEGER FERNANDEZ, Mr. LEVIN of Michigan, Mr. LIEU, Mr. 

LOWENTHAL, Mrs. CAROLYN B. MALONEY of New York, Mr. MCGOVERN, Mr. MEEKS, Ms. MENG, Ms. MOORE of Wisconsin, Mr. NADLER, 

Mrs. NAPOLITANO, Ms. NEWMAN, Ms. NORTON, Ms. OCASIO-CORTEZ, 

Ms. OMAR, Mr. PANETTA, Mr. PAYNE, Mr. PERLMUTTER, Ms. PINGREE, 

Mr. POCAN, Ms. PRESSLEY, Ms. ROYBAL-ALLARD, Mr. RUSH, Ms. SCANLON, Ms. SCHAKOWSKY, Mr. SIRES, Mr. SOTO, Ms. SPEIER, Mr. 

TAKANO, Ms. TLAIB, Mrs. TORRES of California, Mr. TORRES of New 

York, Mr. TRONE, Mr. VARGAS, Mr. VEASEY, Mr. VELA, Ms. 

VELA ́ZQUEZ, Ms. WASSERMAN SCHULTZ, Mrs. WATSON COLEMAN, Mr. 

WELCH, Ms. WILLIAMS of Georgia, and Ms. WILSON of Florida) 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 


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A BILL 

To expand access to health care 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, 

3 SECTION 1. SHORT TITLE. 

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

5 Access under the Law for Immigrant Families Act of 

6 2021’’ or the ‘‘HEAL for Immigrant Families Act of 

7 2021’’. 

8 SEC. 2. FINDINGS; PURPOSE. 

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

10 (1) Health insurance coverage reduces harmful 

11 racial, economic, gender, and health inequities by al12 leviating cost barriers to, and increasing utilization 

13 of, necessary health care services, especially among 

14 low-income and underserved populations. 

15 (2) Based solely on their immigration status, 

16 many immigrants and their families face legal and 

17 policy restrictions on their ability to obtain afford18 able health insurance coverage through Medicaid, 

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

20 and the health insurance exchanges. 


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1 (3) Lack of health insurance coverage contrib2 utes to persistent inequities in the prevention, diag3 nosis, and treatment of health conditions. This leads 

4 to negative health outcomes for immigrants and 

5 their families, especially Black, Indigenous, Latinx, 

6 Asian, Pacific Islander, and other Immigrants of 

7 Color. 

8 (4) Black immigrant women often cite cost as 

9 a major barrier to health care. Many who are un10 documented forgo doctor visits altogether due to the 

11 financial burden in addition to consistent racial bias 

12 by medical practitioners and racism in health care. 

13 (5) Nearly half of immigrant women are of re14 productive age. Immigrant women, lesbian, gay, bi15 sexual, transgender, and queer (LGBTQ) immi16 grants, and immigrants with disabilities dispropor17 tionately live in households with low incomes and 

18 lack health insurance coverage. Legal and policy bar19 riers to affordable health insurance coverage signifi20 cantly exacerbate their risk of negative pregnancy21 related and other reproductive and sexual health 

22 outcomes, with lasting health and economic con23 sequences for immigrant women, LGBTQ immi24 grants, immigrants with disabilities, and their fami25 lies and society as a whole. 


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1 (6) Immigrants who identify as LGBTQ experi2 ence compounding discrimination from health care 

3 providers and systems based on race and ethnicity, 

4 primary language, immigration status, sexual ori5 entation, and gender identity. Nearly one in five 

6 transgender patients have been refused care due to 

7 their gender non-conforming status, and providers 

8 have denied care to undocumented immigrants be9 cause of immigration status. These inequities are ex10 acerbated by legal and policy barriers that restrict 

11 access to health coverage on the basis of immigra12 tion status, exposing LGBTQ immigrant commu13 nities to disproportionate gaps in affordable, com14 prehensive health care. These compounding barriers 

15 are especially harmful for LGBTQ immigrants who 

16 are escaping interpersonal and state violence due to 

17 their sexual orientation and gender identity. 

18 (7) Denying health insurance coverage or im19 posing waiting periods for health insurance coverage 

20 on the basis of immigration status unfairly hinders 

21 immigrants’ ability to reach and maintain their opti22 mal levels of health and undermines the economic 

23 well-being of their families. 

24 (8) International human rights standards hold 

25 that governments have an affirmative obligation to 


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1 ensure that everyone, including immigrants, can ac2 cess safe, respectful, culturally and linguistically ap3 propriate, and high-quality pregnancy-related care, 

4 including postpartum care, free from discrimination 

5 or violence. Medicaid is the nation’s single largest 

6 payer for pregnancy-related care. Nevertheless, bar7 riers to health coverage persist for pregnant and 

8 postpartum people, particularly immigrants. 

9 (9) Immigrants—especially Black, Indigenous, 

10 Latinx, Asian, and Pacific Islander immigrants—are 

11 among those most harmed by the United States’ 

12 pregnancy-related morbidity and mortality epidemic, 

13 which is the worst among high-income nations. 

14 Black people are nearly four times more likely than 

15 white people to suffer pregnancy-related death, and 

16 twice as likely to suffer maternal morbidity. Indige17 nous people are two and a half times more likely 

18 than white people to die from a pregnancy-related 

19 death. The majority of United States pregnancy-re20 lated deaths are preventable. Lack of access to 

21 health care, immigration status, poverty, and expo22 sure to racism, sexism, and xenophobia in and be23 yond the health care system contribute to the dis24 proportionately high number of pregnancy-related 

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1 ple. Unnecessary barriers that limit pregnant and 

2 postpartum immigrants’ access to health care under3 mine their health, safety, and human rights. 

4 (10) One in seven United States residents is 

5 foreign-born, approximately one in four children in 

6 the United States has at least one immigrant par7 ent, and the population of immigrant families in the 

8 United States is expected to continue to grow in the 

9 coming years. It is therefore in our collective public 

10 health and economic interest to remove legal and 

11 policy barriers to affordable health insurance cov12 erage that are based on immigration status. 

13 (11) Although individuals granted relief under 

14 the Deferred Action for Childhood Arrivals (DACA) 

15 program are authorized to live and work in the 

16 United States, they have been unfairly excluded 

17 from the definitions of lawfully present and lawfully 

18 residing for purposes of health insurance coverage 

19 provided through the Department of Health and 

20 Human Services, including Medicaid, CHIP, and the 

21 health insurance exchanges. 

22 (12) Since immigration law evolves constantly, 

23 new immigration categories for individuals with fed24 erally authorized presence in the United States may 

25 be created. 


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1 (13) Some States continue to unwisely restrict 

2 Medicaid access for immigrants who have long re3 sided in the United States, fueling significant health 

4 inequities and increasing health care costs for indi5 viduals and the public. 

6 (14) Congress restored Medicaid eligibility for 

7 individuals living in the United States under the 

8 Compacts of Free Association as part of bipartisan 

9 legislation in December 2020 and should build on 

10 that success by ensuring all immigrants can access 

11 care. 

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

13 (1) ensure that all individuals who are lawfully 

14 present in the United States are eligible for all fed15 erally funded health care programs; 

16 (2) advance the ability of undocumented indi17 viduals to obtain health insurance coverage through 

18 the health insurance exchanges established under 

19 part II of the Patient Protection and Affordable 

20 Care Act, Public Law 111–148; 

21 (3) eliminate the authority for States to restrict 

22 Medicaid eligibility for lawful permanent residents; 

23 and 

24 (4) eliminate other barriers to accessing Med25 icaid, CHIP, and other medical assistance. 


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1 SEC. 3. REMOVING BARRIERS TO HEALTH COVERAGE FOR 

2 LAWFULLY RESIDING INDIVIDUALS. 

3 (a) MEDICAID.—Section 1903(v)(4) of the Social Se4 curity Act (42 U.S.C. 1396b(v)(4)) is amended— 

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

6 follows: 

7 ‘‘(A) Notwithstanding sections 401(a), 

8 402(b), 403, and 421 of the Personal Responsi9 bility and Work Opportunity Reconciliation Act 

10 of 1996, a State shall provide medical assist11 ance under this title, to individuals who are 

12 lawfully residing in the United States (including 

13 individuals described in paragraph (1), battered 

14 individuals described in section 431(c) of such 

15 Act, and individuals with an approved or pend16 ing application for deferred action or other fed17 erally authorized presence), if they otherwise 

18 meet the eligibility requirements for medical as19 sistance under the State plan approved under 

20 this title (other than the requirement of the re21 ceipt of aid or assistance under title IV, supple22 mental security income benefits under title 

23 XVI, or a State supplementary payment).’’; 

24 (2) by amending subparagraph (B) to read as 

25 follows: 


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1 ‘‘(B) No debt shall accrue under an affi2 davit of support against any sponsor of an indi3 vidual provided medical assistance under sub4 paragraph (A) on the basis of provision of as5 sistance to such individual and the cost of such 

6 assistance shall not be considered as an unreim7 bursed cost.’’; and 

8 (3) in subparagraph (C)— 

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

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

11 application of subparagraph (A)’’; 

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

13 after ‘‘lawfully reside’’; and 

14 (C) by inserting ‘‘or present’’ after ‘‘law15 fully residing’’ each place it appears. 

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

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

18 amended to read as follows: 

19 ‘‘(N) Paragraph (4) of section 1903(v) (re20 lating to lawfully present individuals).’’. 

21 (c) EFFECTIVE DATE.— 

22 (1) IN GENERAL.—Except as provided in para23 graph (2), the amendments made by this section 

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


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1 and shall apply to services furnished on or after the 

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

3 (2) EXCEPTION IF STATE LEGISLATION RE4 QUIRED.—In the case of a State plan for medical as5 sistance under title XIX, or a State child health plan 

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

7 Secretary of Health and Human Services determines 

8 requires State legislation (other than legislation ap9 propriating funds) in order for the plan to meet the 

10 additional requirements imposed by the amendments 

11 made by this section, the respective State plan shall 

12 not be regarded as failing to comply with the re13 quirements of such title solely on the basis of its 

14 failure to meet these additional requirements before 

15 the first day of the first calendar quarter beginning 

16 after the close of the first regular session of the 

17 State legislature that begins after the date of enact18 ment of this Act. For purposes of the previous sen19 tence, in the case of a State that has a 2-year legis20 lative session, each year of such session shall be 

21 deemed to be a separate regular session of the State 

22 legislature. 


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1 SEC. 4. CONSISTENCY IN HEALTH INSURANCE COVERAGE 

2 FOR INDIVIDUALS WITH FEDERALLY AU3 THORIZED PRESENCE, INCLUDING DE4 FERRED ACTION. 

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

6 any of the provisions described in subsection (b), all indi7 viduals granted federally authorized presence in the 

8 United States shall be considered to be lawfully present 

9 in the United States. 

10 (b) PROVISIONS DESCRIBED.—The provisions de11 scribed in this subsection are the following: 

12 (1) EXCHANGE ELIGIBILITY.—Section 1411 of 

13 the Patient Protection and Affordable Care Act (42 

14 U.S.C. 18031). 

15 (2) REDUCED COST-SHARING ELIGIBILITY.— 

16 Section 1402 of the Patient Protection and Afford17 able Care Act (42 U.S.C. 18071). 

18 (3) PREMIUM SUBSIDY ELIGIBILITY.—Section 

19 36B of the Internal Revenue Code of 1986 (26 

20 U.S.C. 36B). 

21 (4) MEDICAID AND CHIP ELIGIBILITY.—Titles 

22 XIX and XXI of the Social Security Act, including 

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

24 1396b(v)). 

25 (c) EFFECTIVE DATE.— 


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1 (1) IN GENERAL.—Subsection (a) shall take ef2 fect on the date of enactment of this Act. 

3 (2) TRANSITION THROUGH SPECIAL ENROLL4 MENT PERIOD.—In the case of an individual de5 scribed in subsection (a) who, before the first day of 

6 the first annual open enrollment period under sub7 paragraph (B) of section 1311(c)(6) of the Patient 

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

9 18031(c)(6)) beginning after the date of enactment 

10 of this Act, is granted federally authorized presence 

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

12 subsection, qualifies for a subsidy under a provision 

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

14 the Secretary of Health and Human Services shall 

15 establish a special enrollment period under subpara16 graph (C) of such section 1311(c)(6) during which 

17 such individual may enroll in qualified health plans 

18 through Exchanges under title I of the Patient Pro19 tection and Affordable Care Act and qualify for such 

20 a subsidy. For such an individual who has been 

21 granted federally authorized presence in the United 

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

23 special enrollment period shall begin not later than 

24 90 days after such date of enactment. Nothing in 

25 this paragraph shall be construed as affecting the 


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1 authority of the Secretary to establish additional 

2 special enrollment periods under such subparagraph 

3 (C). 

4 SEC. 5. REMOVING CITIZENSHIP AND IMMIGRATION BAR5 RIERS TO ACCESS TO AFFORDABLE HEALTH 

6 CARE UNDER THE ACA. 

7 (a) IN GENERAL.— 

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

9 the Internal Revenue Code of 1986 is amended— 

10 (A) in subsection (c)(1)(B)— 

11 (i) by amending the heading to read 

12 as follows: ‘‘SPECIAL RULE FOR CERTAIN

13 INDIVIDUALS INELIGIBLE FOR MEDICAID

14 DUE TO STATUS’’; and 

15 (ii) by amending clause (ii) to read as 

16 follows: 

17 ‘‘(ii) the taxpayer is a noncitizen who 

18 is not eligible for the Medicaid program 

19 under title XIX of the Social Security Act 

20 by reason of the individual’s immigration 

21 status,’’. 

22 (B) by striking subsection (e). 

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

24 of the Patient Protection and Affordable Care Act 

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1 section (e) and redesignating subsection (f) as sub2 section (e). 

3 (3) BASIC HEALTH PROGRAM ELIGIBILITY.— 

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

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

6 amended by striking ‘‘lawfully present in the United 

7 States,’’. 

8 (4) RESTRICTIONS ON FEDERAL PAYMENTS.— 

9 Section 1412 of the Patient Protection and Afford10 able Care Act (42 U.S.C. 18082) is amended by 

11 striking subsection (d) and redesignating subsection 

12 (e) as subsection (d). 

13 (5) REQUIREMENT TO MAINTAIN MINIMUM ES14 SENTIAL COVERAGE.—Subsection (d) of section 

15 5000A of the Internal Revenue Code of 1986 is 

16 amended by striking paragraph (3) and by redesig17 nating paragraph (4) as paragraph (3). 

18 (b) CONFORMING AMENDMENTS.— 

19 (1) ESTABLISHMENT OF PROGRAM.—Section 

20 1411(a) of the Patient Protection and Affordable 

21 Care Act (42 U.S.C. 18081(a)) is amended by strik22 ing paragraph (1) and redesignating paragraphs (2), 

23 (3), and (4) as paragraphs (1), (2), and (3), respec24 tively. 


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

2 of the Patient Protection and Affordable Care Act 

3 (42 U.S.C. 18032(f)) is amended— 

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

5 LIMITED TO CITIZENS AND LAWFUL RESI6 DENTS’’; and 

7 (B) by striking paragraph (3). 

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

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

10 years, as applicable, beginning after December 31, 2021. 

11 SEC. 6. PRESERVING ACCESS TO COVERAGE. 

12 (a) IN GENERAL.—Nothing in this Act, including the 

13 amendments made by this Act, shall prevent lawfully 

14 present noncitizens who are ineligible for full benefits 

15 under the Medicaid program under title XIX of the Social 

16 Security Act from securing a credit for which such lawfully 

17 present noncitizens would be eligible under section 

18 36B(c)(1)(B) of the Internal Revenue Code of 1986 and 

19 under the Medicaid provisions for lawfully present nonciti20 zens, as in effect on the date prior to the date of enact21 ment of this Act. 

22 (b) DEFINITION.—For purposes of subsection (a), 

23 the term ‘‘full benefits’’ means, with respect to an indi24 vidual and State, medical assistance for all services cov25 ered under the State plan under title XIX of the Social 


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1 Security Act that is not less in amount, duration, or scope, 

2 or is determined by the Secretary of Health and Human 

3 Services to be substantially equivalent to the medical as4 sistance available for an individual described in section 

5 1902(a)(10)(A)(i) of the Social Security Act (42 U.S.C. 

6 1396a(a)(10)(A)(i)). 

Æ 


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