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

This proposal expands access to health coverage for many immigrants and their families. It requires states to cover people who are lawfully living in the U.S. under Medicaid and CHIP if they meet the usual income and other rules. This includes people with deferred action and certain survivors of abuse. Sponsors would not be billed for the cost of this care. Most Medicaid/CHIP changes start 90 days after the law is enacted, with extra time if a state needs to pass its own law . People granted a federally authorized presence would count as “lawfully present” for Marketplace plans, discounts on premiums and cost-sharing, and for Medicaid/CHIP. A special Marketplace sign-up window would open within 90 days for those already authorized when the law takes effect .

It also lets states choose to cover certain people without lawful status under Medicaid and CHIP if they would otherwise qualify based on income or pregnancy/child status. It updates federal rules so states can make this choice, and it clarifies that longtime federal limits do not block these state options . For the Affordable Care Act, it removes immigration-related barriers so noncitizens who cannot get Medicaid due to status can receive premium tax credits and cost-sharing help, starting after December 31, 2025. It keeps current tax-credit access for lawfully present people who still cannot get full Medicaid benefits. It also removes immigration wording that kept some lawfully present people from signing up for Medicare Parts A and B .

Key points

• Who is affected: Lawfully present immigrants (including those with deferred action), some survivors of abuse, and, at state option, certain people without lawful status; also people seeking Marketplace help and Medicare enrollment .
• What changes: Broader Medicaid/CHIP eligibility; recognition of federally authorized presence as “lawfully present” for ACA and Medicaid/CHIP; optional state coverage for some without lawful status; continued access to ACA tax credits; removal of Medicare barriers .
• When: Most Medicaid/CHIP changes begin 90 days after enactment; special Marketplace enrollment begins within 90 days of enactment; ACA tax credit changes apply to years starting after December 31, 2025 .