II 119th CONGRESS 1st Session S. 2149 IN THE SENATE OF THE UNITED STATES June 24, 2025 Mr. Booker (for himself, Mr. Heinrich , Mr. Padilla , Ms. Warren , Mrs. Murray , Ms. Hirono , Mr. Sanders , Mr. Blumenthal , and Mr. Markey ) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To expand access to health insurance coverage for immigrants and their families by removing legal and policy barriers to health insurance coverage, and for other purposes.

1. Short title This Act may be cited as the Health Equity and Access under the Law for Immigrant Families Act of 2025 . 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 Federally funded health care programs; (2) advance the ability of undocumented individuals 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 Medicaid, CHIP, and other medical assistance. 3. Removing barriers to health coverage for lawfully residing individuals (a) Medicaid Section 1903(v)(4) of the Social Security 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 Opportunity Reconciliation Act of 1996, a State shall provide medical assistance 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 pending application for deferred action or other Federally authorized presence), if they otherwise meet the eligibility requirements for medical 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 payment). ; (2) by amending subparagraph (B) to read as follows: (B) No debt shall accrue under an affidavit of support against any sponsor of an individual provided medical assistance under subparagraph (A) on the basis of provision of assistance to such individual and the cost of such assistance shall not be considered as an unreimbursed 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 lawfully 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) (relating to lawfully present individuals and undocumented immigrants). . (c) Effective date (1) In general Except as provided in paragraph (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 required In the case of a State plan for medical assistance 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 appropriating 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 requirements 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 enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature. 4. Consistency in health insurance coverage for individuals with Federally authorized presence, including deferred action (a) In general For purposes of eligibility under any of the provisions described in subsection (b), all individuals granted Federally authorized presence in the United States shall be considered to be lawfully present in the United States. (b) Provisions described The provisions described 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 Affordable 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 effect on the date of enactment of this Act. (2) Transition through special enrollment period In the case of an individual described in subsection (a) who, before the first day of the first annual open enrollment period under subparagraph (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 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 subparagraph (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 Protection 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). 5. Removing citizenship and immigration barriers 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)— (i) by amending the heading to read as follows: Special rule for certain individuals ineligible for medicaid due to status ; and (ii) by amending clause (ii) to read as follows: (ii) the taxpayer is a noncitizen who is not eligible for the Medicaid program under title XIX of the Social Security Act by reason of the individual’s immigration status, ; and (B) by striking subsection (e). (2) Cost-sharing reductions Section 1402 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18071 ) is amended by striking subsection (e) and redesignating subsection (f) as subsection (e). (3) Basic health program eligibility Section 1331(e)(1)(B) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18051(e)(1)(B) ) is amended by striking lawfully present in the United States, . (4) Restrictions on Federal payments Section 1412 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18082 ) is amended by striking subsection (d) and redesignating subsection (e) as subsection (d). (5) Requirement to maintain minimum essential coverage Subsection (d) of section 5000A of the Internal Revenue Code of 1986 is amended by striking paragraph (3) and by redesignating paragraph (4) as paragraph (3). (b) Conforming amendments (1) Establishment of program Section 1411(a) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18081(a) ) is amended by striking paragraph (1) and redesignating paragraphs (2), (3), and (4) as paragraphs (1), (2), and (3), respectively. (2) Qualified individuals Section 1312(f) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18032(f) ) is amended— (A) in the heading, by striking ; access limited to citizens and lawful residents ; and (B) by striking paragraph (3). (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. 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 paragraph (1)— (A) in the matter designated as clause (xvi), by striking or at the end; (B) in the matter designated as clause (xvii), by adding or at the end; and (C) by inserting after the matter designated 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 section 2112 the following new section: 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 individual 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 prohibition 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 Security 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. . 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 noncitizens, as in effect on the date prior to the date of enactment of this Act. (b) Definition For purposes of subsection (a), the term full benefits means, with respect to an individual and State, medical assistance for all services covered 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 assistance available for an individual described in section 1902(a)(10)(A)(i) of the Social Security Act ( 42 U.S.C. 1396a(a)(10)(A)(i) ). 8. Removing barriers to health coverage for lawfully present individuals in Medicare (a) Part A Section 1818(a)(3) of the Social Security Act ( 42 U.S.C. 1395i–2(a)(3) ) is amended by striking an alien and all that follows through under this section 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 approved or pending application for deferred action or other Federally authorized presence . (b) Part B Section 1836(a)(2) of the Social Security 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 approved or pending application for deferred action or other Federally authorized presence . (c) Lawfully present defined The term lawfully present shall include, at a minimum, all immigration categories that are treated as lawfully present for purposes of the title XIX program as amended by section 3.