HEAL for Immigrant Women and Families Act of 2020

II 116TH CONGRESS 2D SESSION S. 3799 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 SENATE OF THE UNITED STATES MAY 21, 2020 Mr. BOOKER introduced the following bill; which was read twice and referred to the Committee on Finance 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- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Health Equity and 4 Access under the Law for Immigrant Women and Families 5 Act of 2020’’ or as the ‘‘HEAL for Immigrant Women 6 and Families Act of 2020’’. 7 VerDate Sep 11 2014 04:35 Jun 13, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S3799.IS S3799 kjohnson on DSK79L0C42PROD with BILLS 2 •S 3799 IS SEC. 2. FINDINGS; PURPOSE. 1 (a) FINDINGS.—Congress finds as follows: 2 (1) Health insurance coverage reduces harmful 3 disparities by alleviating cost barriers to and in- 4 creasing utilization of necessary health care services, 5 especially among low-income and underserved popu- 6 lations, including women. 7 (2) Based solely on their immigration status, 8 many immigrants and their families face legal and 9 policy restrictions on their ability to obtain afford- 10 able health insurance coverage through Medicaid, 11 the Children’s Health Insurance Program (CHIP), 12 and the health insurance exchanges. 13 (3) Lack of health insurance coverage contrib- 14 utes to persistent disparities in the prevention, diag- 15 nosis, and treatment of negative health outcomes ex- 16 perienced by immigrants and their families. 17 (4) Nearly half of immigrant women are of re- 18 productive age. Immigrant women are also dis- 19 proportionately living in low-income households and 20 lacking health insurance coverage. Legal and policy 21 barriers to affordable health insurance coverage 22 therefore particularly exacerbate their risk of nega- 23 tive sexual, reproductive, and maternal health out- 24 comes, with lasting health and economic con- 25 VerDate Sep 11 2014 04:35 Jun 13, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S3799.IS S3799 kjohnson on DSK79L0C42PROD with BILLS 3 •S 3799 IS sequences for immigrant women, their families, and 1 society as a whole. 2 (5) Denying health insurance coverage or im- 3 posing waiting periods for health insurance coverage 4 unfairly hinders the ability of immigrants to attain 5 good health and undermines the economic well-being 6 of their families. 7 (6) The population of immigrant families in the 8 United States is expected to continue to grow. One 9 in seven United States residents is foreign-born, and 10 approximately one in four children in the United 11 States has at least one immigrant parent. It is 12 therefore in the Nation’s shared public health and 13 economic interest to remove legal and policy barriers 14 to affordable health insurance coverage based on im- 15 migration status. 16 (7) Although Deferred Action for Childhood Ar- 17 rivals (DACA) recipients are authorized to live and 18 work in the United States, they have been unfairly 19 excluded from the definition of lawfully present and 20 lawfully residing for purposes of health insurance 21 coverage through the Department of Health and 22 Human Services, including Medicaid and CHIP, and 23 the health insurance exchanges. 24 VerDate Sep 11 2014 04:35 Jun 13, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S3799.IS S3799 kjohnson on DSK79L0C42PROD with BILLS 4 •S 3799 IS (8) Immigration law is constantly evolving and 1 new immigration categories for individuals with fed- 2 erally authorized presence in the United States may 3 be created. 4 (b) PURPOSE.—It is the purpose of this Act to— 5 (1) ensure that all individuals who are lawfully 6 present in the United States are eligible for all fed- 7 erally funded health care programs; and 8 (2) advance the ability of undocumented indi- 9 viduals to obtain health insurance coverage through 10 the health insurance exchanges. 11 SEC. 3. REMOVING BARRIERS TO HEALTH COVERAGE FOR 12 LAWFULLY PRESENT INDIVIDUALS. 13 (a) MEDICAID.—Section 1903(v)(4) of the Social Se- 14 curity Act (42 U.S.C. 1396b(v)(4)) is amended— 15 (1) by amending subparagraph (A) to read as 16 follows: 17 ‘‘(A) Notwithstanding sections 401(a), 402(b), 403, 18 and 421 of the Personal Responsibility and Work Oppor- 19 tunity Reconciliation Act of 1996, payment shall be made 20 under this section for care and services that are furnished 21 to individuals who are not citizens of the United States, 22 including aliens described in paragraph (1), if they other- 23 wise meet the eligibility requirements for medical assist- 24 ance under the State plan approved under this title (other 25 VerDate Sep 11 2014 04:35 Jun 13, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S3799.IS S3799 kjohnson on DSK79L0C42PROD with BILLS 5 •S 3799 IS than the requirement of the receipt of aid or assistance 1 under title IV, supplemental security income benefits 2 under title XVI, or a State supplementary payment) and 3 are lawfully present in the United States (including such 4 an individual who is granted deferred action or other fed- 5 erally authorized presence).’’; 6 (2) in subparagraph (B)— 7 (A) by striking ‘‘a State that has elected to 8 provide medical assistance to a category of 9 aliens under subparagraph (A)’’ and inserting 10 ‘‘individuals provided medical assistance pursu- 11 ant to subparagraph (A)’’; and 12 (B) by striking ‘‘such an alien on the basis 13 of provision of assistance to such category’’ and 14 inserting ‘‘such an individual on the basis of 15 provision of assistance to such individual’’; and 16 (3) in subparagraph (C)— 17 (A) by striking ‘‘an election by the State 18 under subparagraph (A)’’ and inserting ‘‘the 19 application of subparagraph (A)’’; 20 (B) by inserting ‘‘or be lawfully present’’ 21 after ‘‘lawfully reside’’; and 22 (C) by inserting ‘‘or present’’ after ‘‘law- 23 fully residing’’ each place it appears. 24 VerDate Sep 11 2014 04:35 Jun 13, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S3799.IS S3799 kjohnson on DSK79L0C42PROD with BILLS 6 •S 3799 IS (b) CHIP.—Subparagraph (N) of section 2107(e)(1) 1 of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 2 amended to read as follows: 3 ‘‘(N) Paragraph (4) of section 1903(v) (re- 4 lating to lawfully present individuals).’’. 5 (c) EFFECTIVE DATE.— 6 (1) IN GENERAL.—Except as provided in para- 7 graph (2), the amendments made by this section 8 shall take effect on the date of enactment of this Act 9 and shall apply to services furnished on or after the 10 date that is 90 days after such date of enactment. 11 (2) EXCEPTION IF STATE LEGISLATION RE- 12 QUIRED.—In the case of a State plan for medical as- 13 sistance under title XIX, or a State child health plan 14 under title XXI, of the Social Security Act which the 15 Secretary of Health and Human Services determines 16 requires State legislation (other than legislation ap- 17 propriating funds) in order for the plan to meet the 18 additional requirements imposed by the amendments 19 made by this section, the respective State plan shall 20 not be regarded as failing to comply with the re- 21 quirements of such title solely on the basis of its 22 failure to meet these additional requirements before 23 the first day of the first calendar quarter beginning 24 after the close of the first regular session of the 25 VerDate Sep 11 2014 04:35 Jun 13, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S3799.IS S3799 kjohnson on DSK79L0C42PROD with BILLS 7 •S 3799 IS State legislature that begins after the date of enact- 1 ment of this Act. For purposes of the previous sen- 2 tence, in the case of a State that has a 2-year legis- 3 lative session, each year of such session shall be 4 deemed to be a separate regular session of the State 5 legislature. 6 SEC. 4. CONSISTENCY IN HEALTH INSURANCE COVERAGE 7 FOR INDIVIDUALS WITH FEDERALLY AU- 8 THORIZED PRESENCE, INCLUDING DE- 9 FERRED ACTION. 10 (a) IN GENERAL.—For purposes of eligibility under 11 any of the provisions described in subsection (b), all indi- 12 viduals granted federally authorized presence in the 13 United States shall be considered to be lawfully present 14 in the United States. 15 (b) PROVISIONS DESCRIBED.—The provisions de- 16 scribed in this subsection are the following: 17 (1) EXCHANGE ELIGIBILITY.—Section 1311 of 18 the Patient Protection and Affordable Care Act (42 19 U.S.C. 18031). 20 (2) REDUCED COST-SHARING ELIGIBILITY.— 21 Section 1402 of the Patient Protection and Afford- 22 able Care Act (42 U.S.C. 18071). 23 VerDate Sep 11 2014 04:35 Jun 13, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S3799.IS S3799 kjohnson on DSK79L0C42PROD with BILLS 8 •S 3799 IS (3) PREMIUM SUBSIDY ELIGIBILITY.—Section 1 36B of the Internal Revenue Code of 1986 (26 2 U.S.C. 36B). 3 (4) MEDICAID AND CHIP ELIGIBILITY.—Titles 4 XIX and XXI of the Social Security Act, including 5 under section 1903(v) of such Act (42 U.S.C. 6 1396b(v)). 7 (c) EFFECTIVE DATE.— 8 (1) IN GENERAL.—Subsection (a) shall take ef- 9 fect on the date of enactment of this Act. 10 (2) TRANSITION THROUGH SPECIAL ENROLL- 11 MENT PERIOD.—In the case of an individual de- 12 scribed in subsection (a) who, before the first day of 13 the first annual open enrollment period under sub- 14 paragraph (B) of section 1311(c)(6) of the Patient 15 Protection and Affordable Care Act (42 U.S.C. 16 18031(c)(6)) beginning after the date of enactment 17 of this Act, is granted federally authorized presence 18 in the United States and who, as a result of such 19 subsection, qualifies for a subsidy under a provision 20 described in paragraph (2) or (3) of subsection (b), 21 the Secretary of Health and Human Services shall 22 establish a special enrollment period under subpara- 23 graph (C) of such section 1311(c)(6) during which 24 such individual may enroll in qualified health plans 25 VerDate Sep 11 2014 04:35 Jun 13, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S3799.IS S3799 kjohnson on DSK79L0C42PROD with BILLS 9 •S 3799 IS through Exchanges under title I of the Patient Pro- 1 tection and Affordable Care Act and qualify for such 2 a subsidy. For such an individual who has been 3 granted federally authorized presence in the United 4 States as of the date of enactment of this Act, such 5 special enrollment period shall begin not later than 6 90 days after such date of enactment. Nothing in 7 this paragraph shall be construed as affecting the 8 authority of the Secretary to establish additional 9 special enrollment periods under such subparagraph 10 (C). 11 SEC. 5. REMOVING CITIZENSHIP AND IMMIGRATION BAR- 12 RIERS TO ACCESS TO AFFORDABLE HEALTH 13 CARE UNDER THE ACA. 14 (a) IN GENERAL.— 15 (1) PREMIUM TAX CREDITS.—Section 36B of 16 the Internal Revenue Code of 1986 is amended— 17 (A) in subsection (c)(1)(B)— 18 (i) by amending the heading to read 19 as follows: ‘‘SPECIAL RULE FOR CERTAIN 20 INDIVIDUALS INELIGIBLE FOR MEDICAID 21 DUE TO STATUS’’; and 22 (ii) in clause (ii), by striking ‘‘lawfully 23 present in the United States, but’’ and in- 24 serting ‘‘who’’; and 25 VerDate Sep 11 2014 04:35 Jun 13, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S3799.IS S3799 kjohnson on DSK79L0C42PROD with BILLS 10 •S 3799 IS (B) by striking subsection (e). 1 (2) COST-SHARING REDUCTIONS.—Section 1402 2 of the Patient Protection and Affordable Care Act 3 (42 U.S.C. 18071) is amended by striking sub- 4 section (e) and redesignating subsection (f) as sub- 5 section (e). 6 (3) BASIC HEALTH PROGRAM ELIGIBILITY.— 7 Section 1331(e)(1)(B) of the Patient Protection and 8 Affordable Care Act (42 U.S.C. 18051(e)(1)(B)) is 9 amended by striking ‘‘lawfully present in the United 10 States,’’. 11 (4) RESTRICTIONS ON FEDERAL PAYMENTS.— 12 Section 1412 of the Patient Protection and Afford- 13 able Care Act (42 U.S.C. 18082) is amended by 14 striking subsection (d) and redesignating subsection 15 (e) as subsection (d). 16 (5) REQUIREMENT TO MAINTAIN MINIMUM ES- 17 SENTIAL COVERAGE.—Subsection (d) of section 18 5000A of the Internal Revenue Code of 1986 is 19 amended by striking paragraph (3) and by redesig- 20 nating paragraph (4) as paragraph (3). 21 (b) CONFORMING AMENDMENTS.— 22 (1) ESTABLISHMENT OF PROGRAM.—Section 23 1411 of the Patient Protection and Affordable Care 24 Act (42 U.S.C. 18081) is amended— 25 VerDate Sep 11 2014 04:35 Jun 13, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S3799.IS S3799 kjohnson on DSK79L0C42PROD with BILLS 11 •S 3799 IS (A) in subsection (a)— 1 (i) by striking paragraph (1); and 2 (ii) redesignating paragraphs (2), (3), 3 and (4) as paragraphs (1), (2), and (3), 4 respectively; 5 (B) in subsection (b)— 6 (i) in paragraph (1)(A), by striking 7 ‘‘and date of birth’’ and inserting ‘‘date of 8 birth, and social security number (if appli- 9 cable)’’; 10 (ii) by striking paragraph (2); and 11 (iii) by redesignating paragraphs (3) 12 through (5) as paragraphs (2) through (4), 13 respectively; 14 (C) in subsection (c)— 15 (i) by striking paragraph (2); 16 (ii) in paragraph (3), by striking 17 ‘‘subsection (b)(3)(A) provided under para- 18 graph (3), (4), or (5)’’ and inserting ‘‘sub- 19 section (b)(2)(A) provided under para- 20 graph (2), (3), or (4)’’; and 21 (iii) by redesignating paragraphs (3) 22 and (4) as paragraphs (2) and (3), respec- 23 tively; 24 (D) in subsection (e)— 25 VerDate Sep 11 2014 04:35 Jun 13, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S3799.IS S3799 kjohnson on DSK79L0C42PROD with BILLS 12 •S 3799 IS (i) in paragraph (1), by striking ‘‘sub- 1 section (c)(4)’’ and inserting ‘‘subsection 2 (c)(3)’’; 3 (ii) in paragraph (2)— 4 (I) in subparagraph (A), by strik- 5 ing ‘‘paragraphs (1), (2), (3), and 6 (4)’’ and inserting ‘‘paragraphs (1), 7 (2), and (3)’’; and 8 (II) in subparagraph (B), by 9 striking ‘‘subsection (b)(5)’’ and in- 10 serting ‘‘subsection (b)(4)’’; 11 (iii) by striking paragraph (3); 12 (iv) by redesignating paragraph (4) as 13 paragraph (3); and 14 (v) in paragraph (3), as so redesig- 15 nated— 16 (I) in subparagraph (A), by strik- 17 ing ‘‘(other than subsection (b)(2))’’; 18 and 19 (II) in subparagraph (B)— 20 (aa) in clause (i)— 21 (AA) by striking ‘‘Ex- 22 cept as provided in para- 23 [Text truncated for display. 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