119-s2149

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 2149 Introduced in Senate

    (IS) ]

<DOC>

119th CONGRESS
 1st Session
 S. 2149

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.

_______________________________________________________________________

 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.

 Be it enacted by the Senate and House of Representatives 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 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.

SEC. 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.

SEC. 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) .

SEC. 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.

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 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:

``

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 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.''.

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 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) ).

SEC. 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.
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