I 
118TH CONGRESS 
1ST SESSION H. R. 5008 
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 
JULY 27, 2023 
Ms. JAYAPAL (for herself, Ms. BARRAGA´N, Ms. ADAMS, Mr. BLUMENAUER, 
Ms. BONAMICI, Mr. BOWMAN, Ms. BUSH, Mr. CARSON, Mr. CARTER of 
Louisiana, Ms. CASTOR
of Florida, Mr. CASTRO
of Texas, Mrs. 
CHERFILUS-MCCORMICK, Ms. CHU, Ms. CLARKE of New York, Mr. 
CLEAVER, Mr. CONNOLLY, Mr. CORREA, Ms. CROCKETT, Mr. DOGGETT, 
Mr. ESPAILLAT, Ms. GARCIA of Texas, Mr. GARCI´A of Illinois, Mr. 
GOMEZ, Mr. GRIJALVA, Ms. JACKSON LEE, Ms. JACOBS, Mr. JOHNSON 
of Georgia, Mr. KRISHNAMOORTHI, Ms. LEE of California, Ms. LOFGREN, 
Mr. MCGOVERN, Ms. MENG, Ms. MOORE of Wisconsin, Mr. NADLER, 
Mrs. NAPOLITANO, Ms. NORTON, Ms. OCASIO-CORTEZ, Ms. OMAR, Ms. 
PINGREE, Mr. POCAN, Ms. PRESSLEY, Mr. QUIGLEY, Mrs. RAMIREZ, Ms. 
SCANLON, Ms. SCHAKOWSKY, Ms. SEWELL, Mr. SOTO, Mr. THANEDAR, 
Ms. TLAIB, Ms. TOKUDA, Mrs. TORRES of California, Mr. TRONE, Mr. 
VEASEY, Ms. VELA´ZQUEZ, Ms. WASSERMAN SCHULTZ, Mrs. WATSON 
COLEMAN, Ms. WILLIAMS of Georgia, Ms. WILSON of Florida, Mrs. 
TRAHAN, Mr. PANETTA, and Mr. CA´RDENAS) 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 sub-
sequently 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 for immigrants 
by removing legal and policy barriers to health insurance 
coverage, and for other purposes. 
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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 
2023’’ or the ‘‘HEAL for Immigrant Families Act of 
2023’’. 
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. 
(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, 
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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. 
(6) 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-
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mal levels of health and undermines the economic 
well-being of their families. 
(7) Like the Hyde amendment’s prohibition on 
public insurance coverage for abortion care, immi-
gration-related health care eligibility barriers have 
long curtailed access to abortion. In June 2022, in 
Dobbs v. Jackson Women’s Health Organization, the 
Supreme Court of the United States overturned the 
constitutional right to abortion, exacerbating pre-ex-
isting barriers. In the year since the Dobbs decision 
was issued, 19 States have banned or restricted 
abortion—disproportionately impacting 15 million 
women of color and millions of transgender and non-
binary people. Notably, in 2022, 39 percent of all 
Latinas living in States that were likely to ban abor-
tion following the Dobbs decision were born outside 
of the United States—this group includes people 
with varying citizenship statuses, among whom fear 
of surveillance may be particularly prevalent, due to 
disproportionate investigation and surveillance that 
many immigrant communities already face. Bans 
and restrictions on abortion exacerbate the fear of 
criminalization in immigrant communities, and con-
tribute to a chilling effect that leads many immi-
grants to forego reproductive health care and cov-
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erage of any kind as they navigate these intersecting 
risks of criminalization. Polling conducted in 2018 
found one in four Latina/o voters (24 percent) had 
a close family member or friend delay or avoid 
health care because of fear related to discriminatory 
immigration policies, and one in five (19 percent) 
said the same about reproductive health care. 
(8) Ensuring access to crucial coverage of re-
productive and sexual health services such as contra-
ception and pregnancy-related care through Med-
icaid and the Affordable Care Act is imperative, with 
only half (52 percent) of immigrants at risk of unin-
tended pregnancy receiving contraceptive care in the 
previous year. Many immigrants are being denied 
the basic human right to make the health care deci-
sions they believe are best for them and their fami-
lies, including abortion care, simply because of their 
immigration status. In States along the Southern 
Border, immigrant communities are subject to inte-
rior checkpoints that increase the threat of family 
separation, deportation, and detention, and com-
pound the harm of abortion restrictions that force 
people to travel to obtain care. Immigrants living 
without documentation, in particular, may have no 
way of obtaining an abortion when immigration en-
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forcement and abortion restrictions combine to pre-
vent them from traveling to a provider. Further, due 
to the high cost of travel associated with the on-
slaught of abortion bans, practical support organiza-
tions that assist with procedure and travel costs 
have been experiencing high demand, and struggle 
with inadequate resources. Accessing support serv-
ices can be out of reach for those without reliable 
technology to research and maintain contact with 
support services, or who encounter linguistic barriers 
when support services are not able to provide trans-
lators. For many, abortion care will be entirely inac-
cessible due to these compounding barriers, thus ex-
acerbating the need for accessible reproductive and 
sexual health services such as contraception and 
pregnancy-related and post-pregnancy care. 
(9) International human rights standards hold 
that governments have an affirmative obligation to 
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-
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riers to health coverage persist for pregnant and 
postpartum people, particularly immigrants. 
(10) 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-
ple. Unnecessary barriers that limit pregnant and 
postpartum immigrants’ access to health care under-
mine their health, safety, and human rights. 
(11) One in seven United States residents is 
foreign-born, approximately one in four children in 
the United States has at least one immigrant par-
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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. 
(12) Delaying or denying health insurance cov-
erage because of immigration status can impede 
mental health and substance use prevention and 
early intervention interventions. Not acknowledging 
the impacts of trauma can impact mental health and 
substance use, and conditions may increase in sever-
ity without appropriate and consistent support and 
treatment. 
(13) 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. 
(14) On April 26, 2023, the Centers for Medi-
care & Medicaid Services (CMS) published a pro-
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posed rule that would modify the definition of ‘‘law-
fully present’’ used to determine eligibility for Pa-
tient Protection and Affordable Care Act (ACA) 
health plans and certain other health care programs. 
Codifying these protections in legislation is crucial to 
ensure individuals granted relief under the Deferred 
Action for Childhood Arrivals (DACA) program and 
those who gain new forms of administrative relief 
are not similarly excluded in future administrative 
action. This is even more imperative as more than 
a quarter of DACA recipients are currently unin-
sured as they await the finalization of the proposed 
rule. 
(15) Since immigration law evolves constantly, 
new immigration categories for individuals with fed-
erally authorized presence in the United States may 
be created. 
(16) 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. 
(17) Congress restored Medicaid eligibility for 
individuals living in the United States under the 
Compacts of Free Association as part of bipartisan 
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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. 
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-
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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-
sistance to such individual and the cost of such 
assistance shall not be considered as an unreim-
bursed cost.’’; and 
(3) in subparagraph (C)— 
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(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 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-
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-
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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 
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: 
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(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 
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 
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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.— 
(1) PREMIUM TAX CREDITS.—Section 36B of 
the Internal Revenue Code of 1986 is amended— 
(A) in subsection (c)(1)(B)— 
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