I 
119TH CONGRESS 
1ST SESSION H. R. 4104 
To expand access to health insurance coverage for immigrants and their 
families by removing legal and policy barriers to health insurance cov-
erage, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 24, 2025 
Ms. JAYAPAL (for herself, Ms. BARRAGA´N, Ms. BALINT, Mr. BEYER, Ms. 
BONAMICI, Mr. CARBAJAL, Mr. CARSON, Mr. CARTER of Louisiana, Mr. 
CASAR, Ms. CASTOR of Florida, Mr. CASTRO of Texas, Mrs. CHERFILUS- 
MCCORMICK, Ms. CHU, Ms. CROCKETT, Ms. DELBENE, Ms. DEXTER, 
Mr. DOGGETT, Mr. ESPAILLAT, Mr. FROST, Mr. GARCI´A of Illinois, Mr. 
GARCIA of California, Ms. GARCIA of Texas, Mr. GOMEZ, Mr. HUFFMAN, 
Mr. JACKSON of Illinois, Ms. JACOBS, Mr. JOHNSON of Georgia, Mr. 
KHANNA, Mr. KRISHNAMOORTHI, Ms. LEGER FERNANDEZ, Ms. MCCLEL-
LAN, Mr. MCGOVERN, Ms. MOORE of Wisconsin, Mr. NADLER, Ms. NOR-
TON, Ms. OMAR, Mr. PANETTA, Mr. POCAN, Ms. PRESSLEY, Mrs. RAMI-
REZ, Ms. SALINAS, Ms. SCHAKOWSKY, Ms. SEWELL, Ms. SIMON, Ms. 
STANSBURY, Ms. STRICKLAND, Mr. THANEDAR, Ms. TLAIB, Mr. VARGAS, 
Ms. VELA´ZQUEZ, Ms. WASSERMAN SCHULTZ, Mrs. WATSON COLEMAN, 
Ms. WILLIAMS of Georgia, Ms. WILSON of Florida, Mr. LIEU, and Ms. 
SA´NCHEZ) introduced the following bill; which was referred to the Com-
mittee 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 insurance coverage for immi-
grants and their families by removing legal and policy 
barriers to health insurance coverage, and for other pur-
poses. 
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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 
2025’’. 
SEC. 2. 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. 
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— 
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(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: 
‘‘(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-
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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 (P) of section 2107(e)(1) 
of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 
amended to read as follows: 
‘‘(P) Paragraph (4) of section 1903(v) (re-
lating to lawfully present individuals and un-
documented immigrants).’’. 
(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 
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-
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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. 
SEC. 4. CONSISTENCY IN HEALTH INSURANCE COVERAGE 
FOR INDIVIDUALS WITH FEDERALLY AU-
THORIZED 
PRESENCE, 
INCLUDING 
DE-
FERRED ACTION. 
(a) IN GENERAL.—For purposes of eligibility under 
any of the provisions described in subsection (b), all indi-
viduals granted Federally authorized presence in the 
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United States shall be considered to be lawfully present 
in the United States. 
(b) PROVISIONS DESCRIBED.—The provisions de-
scribed in this subsection are the following: 
(1) EXCHANGE ELIGIBILITY.—Section 1411 of 
the Patient Protection and Affordable Care Act (42 
U.S.C. 18031). 
(2) REDUCED
COST-SHARING
ELIGIBILITY.— 
Section 1402 of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18071). 
(3) PREMIUM
SUBSIDY
ELIGIBILITY.—Section 
36B of the Internal Revenue Code of 1986 (26 
U.S.C. 36B). 
(4) MEDICAID AND CHIP ELIGIBILITY.—Titles 
XIX and XXI of the Social Security Act, including 
under section 1903(v) of such Act (42 U.S.C. 
1396b(v)). 
(c) EFFECTIVE DATE.— 
(1) IN GENERAL.—Subsection (a) shall take ef-
fect on the date of enactment of this Act. 
(2) TRANSITION
THROUGH
SPECIAL
ENROLL-
MENT
PERIOD.—In the case of an individual de-
scribed in subsection (a) who, before the first day of 
the first annual open enrollment period under sub-
paragraph (B) of section 1311(c)(6) of the Patient 
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Protection and Affordable Care Act (42 U.S.C. 
18031(c)(6)) beginning after the date of enactment 
of this Act, is granted Federally authorized presence 
in the United States and who, as a result of such 
subsection, qualifies for a subsidy under a provision 
described in paragraph (2) or (3) of subsection (b), 
the Secretary of Health and Human Services shall 
establish a special enrollment period under subpara-
graph (C) of such section 1311(c)(6) during which 
such individual may enroll in qualified health plans 
through Exchanges under title I of the Patient Pro-
tection and Affordable Care Act and qualify for such 
a subsidy. For such an individual who has been 
granted Federally authorized presence in the United 
States as of the date of enactment of this Act, such 
special enrollment period shall begin not later than 
90 days after such date of enactment. Nothing in 
this paragraph shall be construed as affecting the 
authority of the Secretary to establish additional 
special enrollment periods under such subparagraph 
(C). 
SEC. 5. REMOVING CITIZENSHIP AND IMMIGRATION BAR-
RIERS TO ACCESS TO AFFORDABLE HEALTH 
CARE UNDER THE ACA. 
(a) IN GENERAL.— 
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(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to years, plan years, and taxable 
years, as applicable, beginning after December 31, 2025. 
SEC. 6. STATE OPTION TO EXPAND MEDICAID AND CHIP TO 
INDIVIDUALS WITHOUT LAWFUL PRESENCE. 
(a) MEDICAID.— 
(1) IN
GENERAL.—Section 1902(a)(10)(A)(ii) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396a(a)(10)(A)(ii)) is amended— 
(A) in subclause (XXII), by striking ‘‘or’’ 
at the end; 
(B) in subclause (XXIII), by striking the 
semicolon and inserting ‘‘; or’’; and 
(C) by adding at the end the following new 
subclause: 
‘‘(XXIV) who would be eligible 
under the State plan (or waiver of 
such plan) under this title if they were 
citizens of the United States;’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
1905(a) of the Social Security Act (42 U.S.C. 
1396d(a)) is amended, in the matter preceding para-
graph (1)— 
(A) in the matter designated as clause 
(xvi), by striking ‘‘or’’ at the end; 
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(B) in the matter designated as clause 
(xvii), by adding ‘‘or’’ at the end; and 
(C) by inserting after the matter des-
ignated as clause (xvii) the following: 
‘‘(xviii) 
individuals 
described 
in 
section 
1902(a)(10)(A)(ii)(XXIV),’’. 
(b) CHIP.—Title XXI of the Social Security Act (42 
U.S.C. 1397aa et seq.) is amended by inserting after sec-
tion 2112 the following new section: 
‘‘SEC. 2112A. STATE OPTION TO PROVIDE COVERAGE FOR 
INDIVIDUALS WITHOUT LAWFUL PRESENCE. 
‘‘A State may elect through an amendment to its 
State child health plan under section 2102 to treat an in-
dividual as a targeted low-income child or a targeted low- 
income pregnant woman for purposes of this title if such 
individual would otherwise be included as such a child or 
such a pregnant woman (as applicable) under such plan 
if the individual were a citizen of the United States.’’. 
(c) NONAPPLICATION
OF
ELIGIBILITY
PROHIBI-
TION.—Section 401(a) of the Personal Responsibility and 
Work Opportunity Reconciliation Act of 1996 (42 U.S.C. 
1611(a)) is amended by adding at the end the following 
new sentence: ‘‘The preceding sentence shall not apply 
with respect to a noncitizen’s eligibility under a State plan 
(or waiver of such plan) under title XIX of the Social Se-
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curity Act or under a State child health plan (or waiver 
of such plan) under title XXI of such Act to the extent 
that such State has elected to make such individual so 
eligible pursuant to section 1902(a)(10)(A)(ii)(XXIV) or 
2112A of such Act, respectively.’’. 
SEC. 7. PRESERVING ACCESS TO COVERAGE. 
(a) IN GENERAL.—Nothing in this Act, including the 
amendments made by this Act, shall prevent lawfully 
present noncitizens who are ineligible for full benefits 
under the Medicaid program under title XIX of the Social 
Security Act from securing a credit for which such lawfully 
present noncitizens would be eligible under section 
36B(c)(1)(B) of the Internal Revenue Code of 1986 and 
under the Medicaid provisions for lawfully present nonciti-
zens, as in effect on the date prior to the date of enact-
ment of this Act. 
(b) DEFINITION.—For purposes of subsection (a), 
the term ‘‘full benefits’’ means, with respect to an indi-
vidual and State, medical assistance for all services cov-
ered under the State plan under title XIX of the Social 
Security Act that is not less in amount, duration, or scope, 
or is determined by the Secretary of Health and Human 
Services to be substantially equivalent to the medical as-
sistance available for an individual described in section 
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1902(a)(10)(A)(i) of the Social Security Act (42 U.S.C. 
1396a(a)(10)(A)(i)). 
SEC. 8. REMOVING BARRIERS TO HEALTH COVERAGE FOR 
LAWFULLY PRESENT INDIVIDUALS IN MEDI-
CARE. 
(a) PART A.—Section 1818(a)(3) of the Social Secu-
rity Act (42 U.S.C. 1395i–2(a)(3)) is amended by striking 
‘‘an alien’’ and all that follows through ‘‘under this sec-
tion’’ and inserting ‘‘an individual who is lawfully present 
(as defined in section 8(c) of the ‘Health Equity and Ac-
cess under the Law for Immigrant Families Act of 2025’) 
in the United States, including an individual with an ap-
proved or pending application for deferred action or other 
Federally authorized presence’’. 
(b) PART B.—Section 1836(a)(2) of the Social Secu-
rity Act (42 U.S.C. 1395o(a)(2)) is amended by striking 
‘‘an alien’’ and all that follows through ‘‘under this part’’ 
and inserting ‘‘an individual who is lawfully present (as 
defined in section 8(c) of the ‘Health Equity and Access 
under the Law for Immigrant Families Act of 2025’) in 
the United States, including an individual with an ap-
proved or pending application for deferred action or other 
Federally authorized presence’’. 
(c) LAWFULLY PRESENT DEFINED.—The term ‘‘law-
fully present’’ shall include, at a minimum, all immigra-
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tion categories that are treated as lawfully present for pur-
poses of the title XIX program as amended by section 3. 
Æ 
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