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 Cali-
fornia, 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 Com-
mittee 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Health Equity and 
Access under the Law for Immigrant Women and Families 
Act of 2014’’ or as the ‘‘HEAL Immigrant Women and 
Families Act of 2014’’. 
SEC. 2. FINDINGS. 
Congress finds as follows: 
(1) Insurance coverage reduces harmful health 
disparities by alleviating cost barriers to and in-
creasing utilization of basic preventive health serv-
ices, especially among low-income and underserved 
populations, and especially among women. 
(2) Based solely on their immigration status, 
many immigrants and their families face legal re-
strictions on their ability to obtain health insurance 
coverage through Medicaid, CHIP, and Health In-
surance Exchanges. 
(3) Lack of health insurance contributes to per-
sistent disparities in the prevention, diagnosis, and 
treatment of negative health outcomes borne by im-
migrants and their families. 
(4) Immigrant women are disproportionately of 
reproductive age, low-income, and lacking health in-
surance coverage. Legal barriers to affordable health 
insurance coverage therefore particularly exacerbate 
their risk of negative sexual, reproductive, and ma-
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ternal health outcomes, with lasting health and eco-
nomic consequences for immigrant women, their 
families, and society as a whole. 
(5) Denying coverage or imposing waiting peri-
ods for coverage unfairly hinders the ability of immi-
grants to take responsibility for their own health 
and economic well-being and that of their families. 
To fully and productively participate in society, ac-
cess to health care is fundamental, which for women 
includes access to the services necessary to plan 
whether and when to have a child. 
(6) The population of immigrant families in the 
United States is expected to continue to grow. In-
deed one in five children in the United States is part 
of an immigrant family. It is therefore in the na-
tion’s shared public health and economic interest to 
remove legal barriers to affordable health insurance 
coverage based on immigration status. 
SEC. 3. REMOVING BARRIERS TO HEALTH COVERAGE FOR 
LAWFULLY PRESENT 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: 
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‘‘(A) Notwithstanding sections 401(a), 402(b), 403, 
and 421 of the Personal Responsibility and Work Oppor-
tunity Reconciliation Act of 1996, payment shall be made 
under this section for care and services that are furnished 
to aliens, including those described in paragraph (1), if 
they otherwise meet the eligibility requirements for med-
ical assistance under the State plan approved under this 
title (other than the requirement of the receipt of aid or 
assistance under title IV, supplemental security income 
benefits under title XVI, or a State supplementary pay-
ment), and are lawfully present in the United States.’’; 
(2) in subparagraph (B)— 
(A) by striking ‘‘a State that has elected to 
provide medical assistance to a category of 
aliens under subparagraph (A)’’ and inserting 
‘‘aliens provided medical assistance pursuant to 
subparagraph (A)’’; and 
(B) by striking ‘‘to such category’’ and in-
serting ‘‘to such alien’’; 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 
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(C) by inserting ‘‘or present’’ after ‘‘law-
fully residing’’ each place it appears. 
(b) CHIP.—Subparagraph (J) of section 2107(e)(1) 
of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 
amended to read as follows: 
‘‘(J) 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 the enactment of this 
Act and shall apply to services furnished on or after 
the date that is 90 days after such date of the enact-
ment. 
(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 
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