Health Equity and Access under the Law for Immigrant Families Act of 2025

This bill opens more paths to health coverage for immigrants and their families. It requires states to cover people who are lawfully living in the U.S. under Medicaid if they meet the usual income and other rules, and it ends state limits on Medicaid for lawful permanent residents. It also says people the federal government allows to be in the U.S. (including those with deferred action) count as “lawfully present” for ACA marketplace plans, premium tax credits, cost-sharing help, and Medicaid/CHIP. Sponsors won’t be billed for Medicaid costs of the people they support. People in this group get a special marketplace sign-up window shortly after the bill takes effect.

The bill removes ACA rules that blocked many noncitizens from getting premium tax credits and cost-sharing help when they can’t get Medicaid because of their status. It also lets states choose to cover undocumented children, pregnant people, and others through Medicaid and CHIP if they’d qualify based on income and need. It keeps tax-credit access for lawfully present people who still can’t get full Medicaid. Finally, it removes immigration-related barriers to buying into Medicare Parts A and B for lawfully present people.

• Who is affected: Lawfully present immigrants (including those with deferred action), their sponsors, and undocumented people in states that opt in; families seeking Medicaid/CHIP, ACA plans, or Medicare.
• What changes: Mandatory Medicaid coverage for lawfully present residents; access to ACA plans with tax credits and cost-sharing help; state option to cover undocumented people via Medicaid/CHIP; sponsors not charged for Medicaid costs; Medicare buy‑in barriers removed.
• When: Marketplace recognition of authorized presence starts at enactment, with a special sign-up within about 90 days; Medicaid/CHIP changes apply to services starting 90 days after enactment; ACA subsidy changes begin for plan/tax years after December 31, 2025.