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. MCGOV-
ERN, 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. SCAN-
LON, 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) intro-
duced 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Health Equity and 
Access under the Law for Immigrant Families Act of 
2021’’ or the ‘‘HEAL for Immigrant Families Act of 
2021’’. 
SEC. 2. FINDINGS; PURPOSE. 
(a) FINDINGS.—Congress finds as follows: 
(1) Health insurance coverage reduces harmful 
racial, economic, gender, and health inequities by al-
leviating cost barriers to, and increasing utilization 
of, necessary health care services, especially among 
low-income and underserved populations. 
(2) Based solely on their immigration status, 
many immigrants and their families face legal and 
policy restrictions on their ability to obtain afford-
able health insurance coverage through Medicaid, 
the Children’s Health Insurance Program (CHIP), 
and the health insurance exchanges. 
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(3) Lack of health insurance coverage contrib-
utes to persistent inequities in the prevention, diag-
nosis, and treatment of health conditions. This leads 
to negative health outcomes for immigrants and 
their families, especially Black, Indigenous, Latinx, 
Asian, Pacific Islander, and other Immigrants of 
Color. 
(4) Black immigrant women often cite cost as 
a major barrier to health care. Many who are un-
documented forgo doctor visits altogether due to the 
financial burden in addition to consistent racial bias 
by medical practitioners and racism in health care. 
(5) Nearly half of immigrant women are of re-
productive age. Immigrant women, lesbian, gay, bi-
sexual, transgender, and queer (LGBTQ) immi-
grants, and immigrants with disabilities dispropor-
tionately live in households with low incomes and 
lack health insurance coverage. Legal and policy bar-
riers to affordable health insurance coverage signifi-
cantly exacerbate their risk of negative pregnancy- 
related and other reproductive and sexual health 
outcomes, with lasting health and economic con-
sequences for immigrant women, LGBTQ immi-
grants, immigrants with disabilities, and their fami-
lies and society as a whole. 
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(6) Immigrants who identify as LGBTQ experi-
ence compounding discrimination from health care 
providers and systems based on race and ethnicity, 
primary language, immigration status, sexual ori-
entation, and gender identity. Nearly one in five 
transgender patients have been refused care due to 
their gender non-conforming status, and providers 
have denied care to undocumented immigrants be-
cause of immigration status. These inequities are ex-
acerbated by legal and policy barriers that restrict 
access to health coverage on the basis of immigra-
tion status, exposing LGBTQ immigrant commu-
nities to disproportionate gaps in affordable, com-
prehensive health care. These compounding barriers 
are especially harmful for LGBTQ immigrants who 
are escaping interpersonal and state violence due to 
their sexual orientation and gender identity. 
(7) Denying health insurance coverage or im-
posing waiting periods for health insurance coverage 
on the basis of immigration status unfairly hinders 
immigrants’ ability to reach and maintain their opti-
mal levels of health and undermines the economic 
well-being of their families. 
(8) International human rights standards hold 
that governments have an affirmative obligation to 
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ensure that everyone, including immigrants, can ac-
cess safe, respectful, culturally and linguistically ap-
propriate, and high-quality pregnancy-related care, 
including postpartum care, free from discrimination 
or violence. Medicaid is the nation’s single largest 
payer for pregnancy-related care. Nevertheless, bar-
riers to health coverage persist for pregnant and 
postpartum people, particularly immigrants. 
(9) Immigrants—especially Black, Indigenous, 
Latinx, Asian, and Pacific Islander immigrants—are 
among those most harmed by the United States’ 
pregnancy-related morbidity and mortality epidemic, 
which is the worst among high-income nations. 
Black people are nearly four times more likely than 
white people to suffer pregnancy-related death, and 
twice as likely to suffer maternal morbidity. Indige-
nous people are two and a half times more likely 
than white people to die from a pregnancy-related 
death. The majority of United States pregnancy-re-
lated deaths are preventable. Lack of access to 
health care, immigration status, poverty, and expo-
sure to racism, sexism, and xenophobia in and be-
yond the health care system contribute to the dis-
proportionately high number of pregnancy-related 
deaths among BIPOC birthing and postpartum peo-
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ple. Unnecessary barriers that limit pregnant and 
postpartum immigrants’ access to health care under-
mine their health, safety, and human rights. 
(10) One in seven United States residents is 
foreign-born, approximately one in four children in 
the United States has at least one immigrant par-
ent, and the population of immigrant families in the 
United States is expected to continue to grow in the 
coming years. It is therefore in our collective public 
health and economic interest to remove legal and 
policy barriers to affordable health insurance cov-
erage that are based on immigration status. 
(11) Although individuals granted relief under 
the Deferred Action for Childhood Arrivals (DACA) 
program are authorized to live and work in the 
United States, they have been unfairly excluded 
from the definitions of lawfully present and lawfully 
residing for purposes of health insurance coverage 
provided through the Department of Health and 
Human Services, including Medicaid, CHIP, and the 
health insurance exchanges. 
(12) Since immigration law evolves constantly, 
new immigration categories for individuals with fed-
erally authorized presence in the United States may 
be created. 
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(13) Some States continue to unwisely restrict 
Medicaid access for immigrants who have long re-
sided in the United States, fueling significant health 
inequities and increasing health care costs for indi-
viduals and the public. 
(14) Congress restored Medicaid eligibility for 
individuals living in the United States under the 
Compacts of Free Association as part of bipartisan 
legislation in December 2020 and should build on 
that success by ensuring all immigrants can access 
care. 
(b) PURPOSE.—It is the purpose of this Act to— 
(1) ensure that all individuals who are lawfully 
present in the United States are eligible for all fed-
erally funded health care programs; 
(2) advance the ability of undocumented indi-
viduals to obtain health insurance coverage through 
the health insurance exchanges established under 
part II of the Patient Protection and Affordable 
Care Act, Public Law 111–148; 
(3) eliminate the authority for States to restrict 
Medicaid eligibility for lawful permanent residents; 
and 
(4) eliminate other barriers to accessing Med-
icaid, CHIP, and other medical assistance. 
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SEC. 3. REMOVING BARRIERS TO HEALTH COVERAGE FOR 
LAWFULLY RESIDING INDIVIDUALS. 
(a) MEDICAID.—Section 1903(v)(4) of the Social Se-
curity Act (42 U.S.C. 1396b(v)(4)) is amended— 
(1) by amending subparagraph (A) to read as 
follows: 
‘‘(A) Notwithstanding sections 401(a), 
402(b), 403, and 421 of the Personal Responsi-
bility and Work Opportunity Reconciliation Act 
of 1996, a State shall provide medical assist-
ance under this title, to individuals who are 
lawfully residing in the United States (including 
individuals described in paragraph (1), battered 
individuals described in section 431(c) of such 
Act, and individuals with an approved or pend-
ing application for deferred action or other fed-
erally authorized presence), if they otherwise 
meet the eligibility requirements for medical as-
sistance under the State plan approved under 
this title (other than the requirement of the re-
ceipt of aid or assistance under title IV, supple-
mental security income benefits under title 
XVI, or a State supplementary payment).’’; 
(2) by amending subparagraph (B) to read as 
follows: 
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‘‘(B) No debt shall accrue under an affi-
davit of support against any sponsor of an indi-
vidual provided medical assistance under sub-
paragraph (A) on the basis of provision of as-
sistance to such individual and the cost of such 
assistance shall not be considered as an unreim-
bursed cost.’’; and 
(3) in subparagraph (C)— 
(A) by striking ‘‘an election by the State 
under subparagraph (A)’’ and inserting ‘‘the 
application of subparagraph (A)’’; 
(B) by inserting ‘‘or be lawfully present’’ 
after ‘‘lawfully reside’’; and 
(C) by inserting ‘‘or present’’ after ‘‘law-
fully residing’’ each place it appears. 
(b) CHIP.—Subparagraph (N) of section 2107(e)(1) 
of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 
amended to read as follows: 
‘‘(N) Paragraph (4) of section 1903(v) (re-
lating to lawfully present individuals).’’. 
(c) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), the amendments made by this section 
shall take effect on the date of enactment of this Act 
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and shall apply to services furnished on or after the 
date that is 90 days after such date of enactment. 
(2) EXCEPTION
IF
STATE
LEGISLATION
RE-
QUIRED.—In the case of a State plan for medical as-
sistance under title XIX, or a State child health plan 
under title XXI, of the Social Security Act which the 
Secretary of Health and Human Services determines 
requires State legislation (other than legislation ap-
propriating funds) in order for the plan to meet the 
additional requirements imposed by the amendments 
made by this section, the respective State plan shall 
not be regarded as failing to comply with the re-
quirements of such title solely on the basis of its 
failure to meet these additional requirements before 
the first day of the first calendar quarter beginning 
after the close of the first regular session of the 
State legislature that begins after the date of enact-
ment of this Act. For purposes of the previous sen-
tence, in the case of a State that has a 2-year legis-
lative session, each year of such session shall be 
deemed to be a separate regular session of the State 
legislature. 
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