I 
116TH CONGRESS 
1ST SESSION H. R. 4701 
To expand access to health care services, including sexual, reproductive, 
and maternal health services, for immigrants by removing legal and 
policy barriers to health insurance coverage, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 16, 2019 
Ms. JAYAPAL (for herself, Ms. HAALAND, Ms. BARRAGA´N, Mr. BLUMENAUER, 
Ms. JUDY CHU of California, Mr. ESPAILLAT, Mr. GALLEGO, Ms. LEE 
of California, Ms. MOORE, Mrs. NAPOLITANO, Ms. NORTON, Mr. POCAN, 
Ms. PRESSLEY, Ms. SCHAKOWSKY, Mr. SOTO, Ms. WILSON of Florida, 
Mr. TAKANO, Mrs. LAWRENCE, Ms. GARCIA of Texas, Mr. JOHNSON of 
Georgia, Ms. MENG, Ms. ROYBAL-ALLARD, and Mr. GRIJALVA) 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 
A BILL 
To expand access to health care services, including sexual, 
reproductive, and maternal health services, for immi-
grants 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, 
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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 2019’’ or as the ‘‘HEAL for Immigrant Women 
and Families Act of 2019’’. 
SEC. 2. FINDINGS; PURPOSE. 
(a) FINDINGS.—Congress finds as follows: 
(1) Health insurance coverage reduces harmful 
disparities by alleviating cost barriers to and in-
creasing utilization of necessary health care services, 
especially among low-income and underserved popu-
lations, including women. 
(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 disparities in the prevention, diag-
nosis, and treatment of negative health outcomes ex-
perienced by immigrants and their families. 
(4) Nearly half of immigrant women are of re-
productive age. Immigrant women are also dis-
proportionately living in low-income households and 
lacking health insurance coverage. Legal and policy 
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barriers to affordable health insurance coverage 
therefore particularly exacerbate their risk of nega-
tive sexual, reproductive, and maternal health out-
comes, with lasting health and economic con-
sequences for immigrant women, their families, and 
society as a whole. 
(5) Denying health insurance coverage or im-
posing waiting periods for health insurance coverage 
unfairly hinders the ability of immigrants to attain 
good health and undermines the economic well-being 
of their families. 
(6) The population of immigrant families in the 
United States is expected to continue to grow. One 
in seven United States residents is foreign-born, and 
approximately one in four children in the United 
States has at least one immigrant parent. It is 
therefore in the Nation’s shared public health and 
economic interest to remove legal and policy barriers 
to affordable health insurance coverage based on im-
migration status. 
(7) Although Deferred Action for Childhood Ar-
rivals (DACA) recipients are authorized to live and 
work in the United States, they have been unfairly 
excluded from the definition of lawfully present and 
lawfully residing for purposes of health insurance 
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coverage through the Department of Health and 
Human Services, including Medicaid and CHIP, and 
the health insurance exchanges. 
(8) Immigration law is constantly evolving and 
new immigration categories for individuals with fed-
erally authorized presence in the United States may 
be created. 
(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; and 
(2) advance the ability of undocumented indi-
viduals to obtain health insurance coverage through 
the health insurance exchanges. 
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: 
‘‘(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 individuals who are not citizens of the United States, 
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including aliens described in paragraph (1), if they other-
wise meet the eligibility requirements for medical assist-
ance 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 payment) and 
are lawfully present in the United States (including such 
an individual who is granted deferred action or other fed-
erally authorized presence).’’; 
(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 
‘‘individuals provided medical assistance pursu-
ant to subparagraph (A)’’; and 
(B) by striking ‘‘such an alien on the basis 
of provision of assistance to such category’’ and 
inserting ‘‘such an individual on the basis of 
provision of assistance to such individual’’; 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 (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 
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 
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