HLA submits comments to the Centers for Medicare & Medicaid ...

1 77 Fed. Reg. 52614 (August 30, 2012).
2 See 42 U.S.C. § 18091(2)(C).
3 See 45 CFR 152.2(4)(v) and 152.14(a) (lawfully present individuals are eligible to enroll in a
PCIP, and “lawfully present” includes “aliens currently in deferred action status”).
4 See USCIS, Consideration of Deferred Action for Childhood Arrivals Process, Frequently
Asked Questions (September 14, 2012), available at http://tinyurl.com/9t5maht.
5 77 Fed. Reg. 52614 (August 30, 2012).
6 Ctrs. For Medicare & Medicaid Servs., State Health Official Letter – Individuals with Deferred
Action for Childhood Arrivals, August 28, 2012, SHO #12-002, available at
http://www.medicaid.gov/Federal-Policy-Guidance/downloads/SHO-12-002.pdf.
7 See 8 C.F.R. § 274a.12(c)(14); see also USCIS Frequently Asked Questions, supra note 4.
8 Moreover, the majority of DACA recipients already have no access to another cornerstone
provision of the ACA: dependent coverage. Dependent coverage allows parents to keep their
children on family health insurance plans until the children turn 26 years old. DACA young
adults, however, are largely unable to access dependent coverage because of the unlawful status
of their parents or parental ineligibility for group insurance coverage. These young adults,
therefore, demonstrate substantial inability to access health care insurance without coverage
under the PCIP program.
9 See USCIS, Consideration of Deferred Action for Childhood Arrivals Process (September 14,
2012), available at http://tinyurl.com/7ksa6of (requiring that DACA applicants, in addition to the
other criteria, have been under the age of 31 as of June 15, 2012 and have arrived in the U.S.
before turning 16 years old.)
10 See Sharon Silow-Carroll and Diana Rodin et al, Commonwealth Fund, Health Insurance
Exchanges: State Roles in Selecting Health Plans and Avoiding Adverse Selection, States in
Action (February/March 2011), available at
http://www.commonwealthfund.org/Newsletters/States-in-Action/2011/Mar/February-March-
2011/Feature/Feature.aspx (“Adverse selection refers to the disproportionate enrollment of highrisk,
high-cost individuals, resulting in a rise in costs and premiums. This could result from
lower-risk people [such as young, healthy people] … dropping out of the exchange”).
11 See Ctrs. For Medicare & Medicaid Servs., State Health Official Letter – Medicaid and CHIP
Coverage of “Lawfully Residing” Children and Pregnant Women, July 1, 2010, SHO #10-006,
CHIPRA #17, available at http://downloads.cms.gov/cmsgov/archiveddownloads/SMDL/downloads/SHO10006.pdf
(stating that “lawfully present” includes certain
aliens paroled for under a year, while disqualifying those “paroled for prosecution, for deferred
inspection, or pending removal proceedings”).
12 See id.
13 See 42 U.S.C. 1396b(v)(4)(A).
14 See CMS CHIPRA Letter, supra note 11; see also Lorianne Sainsbury-Wong and Nancy Ryan,
Health care coverage for lawfully residing aliens: Massachusetts and federal perspectives,
Massachusetts Lawyers Journal (July 2012).
15 See CMS CHIPRA Letter, supra note 11.
16 Specifically, the DACA applicant must show that he/she is currently attending school,
graduated or obtained a certificate of completion from a high school, or that he/she otherwise
obtained a general education development certificate. See USCIS, Consideration of DACA
Process, supra note 9.
17 See id.
5