36B(e)(2), 42 U.S.C. In 2023, that threshold is approximately $177 million. However, in the event that any portion of a final rule is declared invalid, CMS intends that the other proposed changes to the definition of lawfully present and within the changes to the regulations defining qualified noncitizens would be severable. Valuing Time in U.S. Department of Health and Human Services Regulatory Impact Analyses: Conceptual Framework and Best Practices. At the same time, CMS understands that State Medicaid and CHIP agencies are experiencing a significant increase in workload following the end of the Medicaid continuous enrollment condition established under section 6008(b)(3) of the Families First Coronavirus Response Act, as amended by section 5131 of the Consolidated Appropriations Act, 2023, and we seek comment about the impact of this workload or any other operational barriers to implementation for State Exchanges, and State Medicaid, CHIP, and BHP agencies. Federal Register. Advocates hope to see the rule expanded. While CMS believes that there are advantages to implementing these provisions, if finalized, on the proposed November 1, 2023 target effective date, CMS will consider the comments received on this issue as we evaluate the feasibility of a November 1, 2023 effective date or different effective dates, if this proposal is finalized. Start Printed Page 25322 Its absolutely a support group, in many ways, Ruiz says. CC, Title II, sec. of this proposed rule. CMS is not proposing a change from its current policy described in the 2010 SHO regarding individuals who are lawfully present in American Samoa. We propose to add a new section at 42 CFR 435.12 addressing the severability of the provisions proposed in this rule. (12) Has been granted withholding of removal under the Convention Against Torture; (13) Has a pending or approved petition for Special Immigrant Juvenile classification as described in 8 U.S.C. All comments are considered public and will be posted online once the Health and Human Services Department has reviewed them. In 2020, Virginia allowed students who meet certain criteria to be eligible for in-state tuition regardless of their citizenship or immigration status. https://www.kff.org/racial-equity-and-health-policy/fact-sheet/health-coverage-and-care-of-immigrants/. In 2019, Arkansas allowed DACA students or those with federal work permits to receive in-state tuition. 1802118024, 1803118033, 1804118042, 18051, 18054, 18071, and 1808118083. Labour Economics. of this proposed rule. 45 CFR 155.305(f)(1)(ii)(A) and (g)(1)(i)(A). Similarly, for purposes of BHP eligibility, COFA migrants are not considered qualified noncitizens by cross-referencing the BHP definition of lawfully present at 42 CFR 600.5 to 45 CFR 155.20. 42 U.S.C. The experience is deeply frustrating, she says. https://www.medicaid.gov/federal-policy-guidance/downloads/sho-12-002.pdf. Kirkpatricks aim is to expose more Republican lawmakers to Dreamers, in the belief that getting to know immigrants would make them more likely to actively support comprehensive overhauls, says her chief of staff, Abigail OBrien. 19. 46. Our proposed definition of lawfully present at 45 CFR 435.4 includes CNMI Residents at paragraph (15), with an update to reflect the current statute regarding individuals who are CNMI residents. You can either click on the link in your confirmation email or simply re-enter your email address below to confirm it. 1101 of the Patient Protection and Affordable Care Act (Pub. and services, go to Additionally, the CHIPRA 214 option gives States the option to elect to cover lawfully residing pregnant individuals and children in their Medicaid and/or CHIP programs. are not part of the published document itself. USCIS, DACA Litigation Information and Frequently Asked Questions (Nov. 3, 2022). Follow the search instructions on that website to view public comments. If you login and register your print subscription number with your account, youll have unlimited access to the website. Available at We are also proposing to add a cross-reference to this definition at 42 CFR 457.320(c) for purposes of determining eligibility for CHIP. L. 1044), and Executive Order 13132 on Federalism (August 4, 1999). And often on the receiving end of all this vitriol are the interns who pick up the phone, including some Dreamers. To date, these other Federal laws include the Trafficking Victims Protection Act of 2000 (22 U.S.C. Than a result of these most recent rulings, existing DACA recipients retain their grant off DACA and are allowed into apply for (and receive) renewal, but the government cannot grant new DACA applications. Table 4Medicaid/CHIP Projected Expenditures, FY 20242028, States that are currently using only State funds to provide health benefits to DACA recipients are likely to see decreases in State expenditures due to this change, as Federal dollars would be available to help cover this population for the first time.[75]. 1254a; (6) Is granted employment authorization under 8 CFR 274a.12(c); (7) Is a Family Unity beneficiary in accordance with section 301 of Public Law 101649 as amended; or section 1504 of the LIFE Act Amendments of 2000, title XV of H.R. It is CMS' intent that if the rules for one program are found unlawful, the rules for other programs would remain intact. These markup elements allow the user to see how the document follows the I went for several years without health insurance wondering if a medical bill was going to send me to bankruptcy or, even worse, lead to passing away early, Magaa-Salgado said. To native-born Americans, the crisis around legal residency continues to be a problem happening to someone else; they do not feel an acute need to respond. 49. The lawfully present definition proposed at 42 CFR 435.4 is identical to the definition proposed at 45 CFR 155.20, except for two additional paragraphs related to the territories. United States, 7. Increased Federal BHP expenditures of $15 million in 2024, $20 million in 2025, $15 million in 2026 and $15 million in 2027 due to increased enrollment as a result of proposed changes to the definition of lawfully present for purposes of a BHP. Period 50 F.4th 498 (5th Cir. The proposed changes to 45 CFR 152.2 and 155.20 would make DACA recipients eligible to enroll in a QHP through an Exchange, and for APTC and CSRs, if otherwise eligible. We also propose to amend the definition of lawfully present in the BHP regulations at 42 CFR 600.5 to instead cross-reference the definition of lawfully present proposed in this rule at 45 CFR 155.20. 26 U.S.C. and IV.C.2. Dizioli, Allan and Pinheiro, Roberto. documents in the last year, 125 Centers for Medicare & Medicaid Services. Muoz Lopez wouldnt have even been there if she hadnt been the rare college senior who subscribed, and actually read, her local congressmans newsletter. regulatory information on FederalRegister.gov with the objective of This change would promote simplicity and consistency in program administration, and further program The DACA program has been mired in legal challenges for years, while Congress has been unable to reach consensus on broader immigration reforms. 2017. Attachment Requirements. We also propose a minor technical change in paragraph (4) of the proposed definition of lawfully present at 45 CFR 155.20, as compared to the definition of lawfully present currently in paragraph (4)(i) at 45 CFR 152.2, to refer to individuals who are granted, rather than currently in temporary resident status, as this language more accurately refers to how this status is conferred. of this proposed rule would simplify our eligibility verification processes and increase efficiencies for individuals seeking health coverage and State and Federal entities administrating insurance affordability programs. on NARA's archives.gov. You can register for assistance using the child's Social Security number. According to Institute on Taxation and Economic Policy, undocumented immigrants contribute an estimated $11.74 billion to state and local economies each year. We discuss how we calculated our Exchange enrollment estimates earlier in this RIA. DACA student loans and financial aid options. documents in the last year, by the Food and Drug Administration March 2, 2023. The licenses are marked that they cannot be used for federal purposes, like voting. Accordingly, based on the proposed changes at 45 CFR 155.20, SIJs could be considered lawfully present under three possible categories, as applicable: paragraph (9) deferred action; paragraph (10) a pending adjustment of status application; or paragraph (13) a pending or approved SIJ petition. 2022 Open Enrollment Report. More than a third of DACA recipients are estimated to be without health care coverage, HHS said. Start Printed Page 25333 It allows Dreamers to eventually transition to permanent legal resident status if they observe a number of conditions, including finishing or pursuing higher education, keeping a job for more than three years or accepting service in the U.S. military. Tracking DACA Recipients' Access to Health Care. Almost all noncitizens granted an EAD under 8 CFR 274a.12(c) are already considered lawfully present under existing regulations, either at in paragraph (4)(iii) of the defintion at 45 CFR 152.2 or within 45 CFR 152.2 more broadly. In addition, excluding DACA recipients from the lawful labor force may, they tell us, result in the loss of $215 billion in economic activity and an associated $60 billion in federal tax revenue . We seek comment on estimates or data sources we could use to provide quantitative estimates for this benefit. 30. Consistent with the 2010 SHO definition of lawfully present, paragraph (14) of the proposed definition of lawfully present at 42 CFR 435.4 provides that individuals who are lawfully present in American Samoa are considered lawfully present. The ACA generally requires that in order to enroll in a QHP through an Exchange, an individual must be a citizen or national of the United States or an alien lawfully present in the United States.[16] By regular mail. These reasons alone would justify the continued implementation of these policies. DACA, an acronym for Deferred Action for Childhood Arrivals, is a policy that protects around 800,000 young people known as "DREAMers" who entered the United States unlawfully as children.The program does not grant them official legal status or a pathway to citizenship, but it does allow them to apply for a driver's license, social security number, and work permit. 23. [17] He suggests that a Supreme Court blow to DACA may finally force Congress to vote on the Dream Act to avoid that spectacle. DACA recipients must re-register with the U.S. It is nice, she says, when they write letters in support of Dreamers and immigration reform, but she wishes they would do moremaybe sitting down with Catholics in Congress who oppose the Dream Act and pressing them to change their positions, or speaking directly to Catholic voters who look down on Dreamers and other immigrants. The proposed modification to paragraph (13) of the definition of lawfully present at 45 CFR 155.20 would capture individuals who have established eligibility for SIJ classification but do not qualify under paragraph (9) or (10) of the proposed definition of lawfully present at 45 CFR 155.20, and eliminate an unintentional gap in the definition. Under the proposed rule, Exchanges and States would continue to verify that a child has the relevant pending application or is listed as a dependent on a parent's[34] [48] It appears that you have attempted to comment on this document before Financial burden pertaining to BHP and State Exchange information collection changes is covered entirely by States, as discussed further in sections IV.C.2. Paragraph (15) of the proposed definition of lawfully present at 42 CFR 435.4 provides a revised description of lawfully present individuals in the Commonwealth of the Northern Mariana Islands (CNMI) under 48 U.S.C. 18032(f)(3) for the Exchange, and 42 U.S.C. All rights reserved. As discussed previously, the changes proposed to the definition of lawfully present would impact eligibility for Medicaid and CHIP in States that have elected the CHIPRA 214 option. I wish I could have been finding the vaccine for Covid or the cure for cancer and things like that, she says. Block student loan forgiveness. Issuers could possibly be classified in 621491 (HMO Medical Centers) and, if this is the case, the SBA size standard would be $44.5 million or less. must meet when it promulgates a proposed rule (and subsequent final rule) that imposes substantial direct requirement costs on State and local governments, preempts State law, or otherwise has federalism implications. section of this preamble, and, when we proceed with a subsequent document, we will respond to the comments in the preamble to that document. Our estimates for Medicaid and CHIP expenditures as a result of the proposals in this rule, if finalized, are shown in Table 4. and solicit public comment before a collection of information requirement is submitted to the Office of Management and Budget (OMB) for review and approval. L. 101649, enacted November 29, 1990), as amended. Citizenship and Immigration Services. 2. 392 0 obj <>stream The Biden administration's proposed legislation could boost the number of employment-based green cards, which are capped at about 140,000 per year. withholding of removal under 8 U.S.C. https://www.nilc.org/wp-content/uploads/2022/06/NILC_DACA-Report_060122.pdf. [59] Among other things, the DHS DACA Final Rule reiterated USCIS' longstanding policy that a noncitizen who has been granted deferred action is deemed lawfully presenta specialized term of art that Congress has used in multiple statutesfor example, for purposes of 8 U.S.C. The letter was sent to the House Appropriations Committee's Subcommittees on the Legislative Branch and Financial Services and General Government and was signed by 72 . 100 hours) at a cost of $367,829 (39 States [(25 hours $98.50 per hour) + (75 hours $92.92 per hour)]) for completing the necessary updates to Medicaid systems. Notice to DACA Participants The United States Citizenship and Immigration Services suggests that employers remind employees at least 90 days before the workers must reverify their DACA status . Using the per-application processing burden discussed earlier in this ICR (10 minutes, or 0.17 hours, per application at a rate of $46.70 per hour), and applying the 50 percent Federal contribution to Medicaid and CHIP program administration costs, this results in a burden of 1,700 hours, or $79,390, each for States and the Federal Government to process Medicaid and CHIP applications. DACA recipients are required to pay federal income taxes. 05/01/2023, 258 Also see 42 CFR part 600. Relevant information about this document from Regulations.gov provides additional context. [12] Besides the initial shock OK, the next five to 10 years after college are going to look a lot different from what I expected I was pretty disheartened that this was an issue because, as a DACA recipient, you have this work authorization and you think this solves a lot of my problems, Sara says. when they are lawfully residing and meet all other eligibility requirements in the State. Copyright 2023 CQ Roll Call. 1612(b)(3)(C), we acknowledge that COFA migrants would need to be excluded from the definition of qualified noncitizen for separate CHIP through an exception at 42 CFR 457.320(c). In previously excluding DACA recipients from the definition of lawfully present, CMS had posited that the broadly accepted conventions of lawful presence should be set aside if the program or status in question was not established with the explicit objective of expanding access to health insurance affordability programs. We are considering this target date because Open Enrollment is an important opportunity for consumers to shop for and enroll in insurance coverage, and implementation of these changes would be most effective during a period when there are many outreach and enrollment activities occurring from CMS, State Exchanges, Navigator and assister groups, and other interested parties. However, we believe this effect is mitigated because the eligibility change is under an option that States have the discretion to adopt and maintain. Comments, if received, will be responded to within the subsequent final rule. This proposed change is intended to reduce duplication and will not have a substantive impact on the definition of lawfully present.. As of December 2022, those States are California, the District of Columbia, Illinois, Maine, Massachusetts, New York, Oregon, Rhode Island, Vermont, and Washington. The DACA program was started in 2012 to allow undocumented children who came to the U.S. as immigrants a chance to stay and work in the country for two years. Magaa-Salgado has spent years advocating for health insurance for his fellow recipients and all immigrants. Family Unity beneficiaries are individuals who entered the United States and have been continuously residing in the United States since May 1988, and who have a family relationship (spouse or child) to a noncitizen with legalized status.[32] Box 8016, Baltimore, MD 212448016. "We recognize that every day counts, and we expect to get this done by the end of the month," the White House said in a statement. documents in the last year, 19 65. of this proposed rule, which pertains to the streamlined application. (b) The provisions in 435.4 with respect to the definitions of lawfully present and lawfully residing are intended to be severable from one another and from the definitions of lawfully present established at 42 CFR 600.5 and 45 CFR 155.20. 50. edition of the Federal Register. We discuss this authority in further detail later in this section. of this proposed rule, where we discuss this further and we seek comment on whether to provide a more detailed definition of qualified noncitizen at 42 CFR 435.4. Therefore, the Secretary has certified that this proposed rule will not have a significant economic impact on a substantial number of small entities. The Justice Department's filing late Thursday was part of the last set of . The decision halted any further expansion of DACA, cutting off hundreds of thousands of U.S. residents potentially eligible for it. We also propose a nomenclature change to the definitions of citizenship, noncitizen, and qualified noncitizen in 42 CFR 435.4 in order to remove the hyphen in the term non-citizen and use the term noncitizen throughout those definitions to align with terminology used by DHS. Health Coverage and Care of Immigrants, Kaiser Family Foundation, We are presently unable to quantify the number of additional Family Unity beneficiaries, individuals with a pending application for adjustment of status, children under age 14 with a pending application for asylum or related protection or children listed as dependents on a parent's application for asylum or related protection, and individuals with approved petition for SIJ classification that could enroll in health coverage and benefit from the proposals in this rule, but we expect this number to be small. Start Printed Page 25331. Households containing DACA recipients pay $5.6 billion in federal taxes and $3.1 billion in state and local taxes each year. The postpartum period for pregnant individuals includes the 60-day period described in sections 1903(v)(4)(A)(i) and 2107(e)(1)(O) of the Act or the extended 12-month period described in sections 1902(e)(16) and 2107(e)(1)(J) of the Act in States that have elected that option. CMS's target effective date for this rule is November 1, 2023, to ensure the provisions are effective during the Open Enrollment Period for individual market Exchanges, the next of which will begin on November 1, 2023. 11. America is a country of immigrants, and we should legislate accordingly., Sen. Dick Durbin: I have never understood the opposition to DACA and the Dreamers. We are proposing to define the terms lawfully present and lawfully residing at 42 CFR 435.4. This site displays a prototype of a Web 2.0 version of the daily The amendments proposed under 42 CFR 435.4 and 457.320(c) would also revise the description of lawfully present individuals in the CNMI in this definition. The authority citation for part 435 continues to read as follows: Authority: Table 2Summary of Proposed Burden Estimates. This figure encompasses 43,500 DACA recipients who worked in health care and social assistance occupations, including 10,300 in hospitals and 2,000 in nursing care facilities. Deferred Action for Childhood Arrivals (DACA) is a deferred action policy implemented by the Obama administration in June 2012. In the 2010 SHO letter, CMS interpreted lawfully residing to mean individuals who are lawfully present in the United States and who are residents of the State in which they are applying under the State's Medicaid or CHIP residency rules. D to Pub. DACA, created in 2012 by the Obama administration, allows roughly 600,000 immigrants who were brought to the U.S. illegally as children to live and work in the country. As previously stated, for the 200,000 individuals impacted by this rule, the annual additional burden of completing the application would be 0.495 hours per individual on average, which totals to 99,000 hours at a cost of $2,050,290. For the BHPs, if we estimate 6,000 applications would be processed, the burden for all of those would be borne by the States. These factors emphasize how increasing access to health insurance would improve the health and well-being of many DACA recipients currently without coverage. What the heck, I never win any of these things anyway, she recalls thinking. These U.S. residents have been suspended in a bureaucratic limbo since the program began under an executive order by President Barack Obama in 2012. Other Impacts on the Federal Government 9. Nguyen, L.H., Drew, D.A., Graham, M.S., Joshi, A.D., Guo, C.-G., Ma, W., Mehta, R.S., Warner, E.T., Sikavi, D.R., Lo, C.-H., Kwon, S., Song, M., Mucci, L.A., Stampfer, M.J., Willett, W.C., Eliassen, A.H., Hart, J.E., Chavarro, J.E., Rich-Edwards, J.W., . These proposed definitions are solely for the purposes of determining eligibility for specific Department of Health and Human Services (HHS) health programs and are not intended to define lawful presence for purposes of any other law or program. Start Printed Page 25328 ICRs Regarding the Application Process for Applicants, PART 435ELIGIBILITY IN THE STATES, DISTRICT OF COLUMBIA, THE NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA, PART 600ADMINISTRATION, ELIGIBILITY, ESSENTIAL HEALTH BENEFITS, PERFORMANCE STANDARDS, SERVICE DELIVERY REQUIREMENTS, PREMIUM AND COST SHARING, ALLOTMENTS, AND RECONCILIATION, PART 152PRE-EXISTING CONDITION INSURANCE PLAN PROGRAM, PART 155EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT, https://www.federalregister.gov/d/2023-08635, MODS: Government Publishing Office metadata, https://www.bls.gov/oes/current/oes_nat.htm, www.cms.hhs.gov/PaperworkReductionActof1995, https://www.whitehouse.gov/wp-content/uploads/legacy_drupal_files/omb/circulars/A4/a-4.pdf, https://www.cms.gov/cciio/programs-and-initiatives/state-innovation-waivers/section_1332_state_innovation_waivers-, https://downloads.cms.gov/cmsgov/archived-downloads/smdl/downloads/sho10006.pdf, https://www.medicaid.gov/federal-policy-guidance/downloads/sho-12-002.pdf, https://www.dhs.gov/xlibrary/assets/s1-exercising-prosecutorial-discretion-individuals-who-came-to-us-as-children.pdf, https://www.nilc.org/wp-content/uploads/2022/06/NILC_DACA-Report_060122.pdf, https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/, https://cmsny.org/daca-essential-workers-covid/, https://doi.org/10.1016/S2468-2667(20)30164-X, https://doi.org/10.1186/s12879-020-05587-2, https://doi.org/10.1016/j.labeco.2016.03.002, https://www.kff.org/racial-equity-and-health-policy/fact-sheet/key-facts-on-individuals-eligible-for-the-deferred-action-for-childhood-arrivals-daca-program/, https://www.govinfo.gov/content/pkg/FR-2021-01-25/pdf/2021-01769.pdf, https://www.uscis.gov/sites/default/files/document/forms/i-817.pdf, https://www.uscis.gov/sites/default/files/document/forms/i-817instr.pdf, https://www.medicaid.gov/federal-policy-guidance/downloads/sho21007.pdf, https://www.medicaid.gov/medicaid/enrollment-strategies/medicaid-and-chip-coverage-lawfully-residing-children-pregnant-women, https://www.medicaid.gov/basic-health-program/index.html, https://www.govinfo.gov/content/pkg/FR-2022-12-20/pdf/2022-27211.pdf, https://aspe.hhs.gov/reports/valuing-time-us-department-health-human-services-regulatory-impact-analyses-conceptual-framework, https://fred.stlouisfed.org/series/LEU0252881500A, https://www.kff.org/racial-equity-and-health-policy/fact-sheet/health-coverage-and-care-of-immigrants/, https://www.cms.gov/files/document/health-insurance-exchanges-2022-open-enrollment-report-final.pdf, https://www.uscis.gov/sites/default/files/document/data/Active_DACA_Recipients_Sept_FY22_qtr4.pdf, https://www.cdc.gov/nchs/products/nvsr.htm, https://www.sba.gov/document/support--table-size-standards, https://www.cms.gov/CCIIO/Resources/Data-Resources/mlr.html, Clarifying Eligibility for a Qualified Health Plan through an Exchange, Advance Payments of the Premium Tax Credit, Cost-Sharing Reductions, a Basic Health Program, and for Some Medicaid and Childrens Health Insurance Programs (CMS-9894-P), Database and Network Administrator & Architect. Thats why Ruiz, now a naturalized U.S. citizen and working for House Assistant Speaker Katherine M. Clark of Massachusetts, got together with a few other formerly undocumented immigrants to found the Dreamers Congressional Staff Association in 2019. DACA recipients with work authorization may qualify for Job Corps, a no-cost education and vocational training program administered by the U.S. Department of Labor, which helps individuals ages 16 . See The DACA program, created in 2012, allows certain immigrants who arrived in the U.S. as children to live in the United States legally for two years, with protection from deportation and permission . public comments that make threats to individuals or institutions or suggest that the individual will take actions to harm the individual. Thus, under the proposed rule, DACA recipients who are children under 21 years of age (under age 19 for CHIP) or pregnant, including during the If the Supreme Court indeed strikes down DACA, will the American public will have the stomach for nationwide deportations that would send young adults into countries they left as children and often know little about? jparshall@americanprogress.org. We now propose to change this so that children under 14 are considered lawfully present without linking their eligibility to the 180-day waiting period for an EAD. 26 U.S.C. Senate Appropriations Chairman Patrick J. Leahy, D-Vt., did not respond to a request for comment, nor did any of the Republican ranking members on the relevant committees and subcommittees. This modification would add only two minor categories to the proposed definition: noncitizens granted employment authorization under 8 CFR 274a.12(c)(35) and (36).