The U.S. Department of Health and Human Services (HHS) finalized a rule on Friday to expand Affordable Care Act eligibility to Deferred Action for Childhood Arrivals (DACA), or Dreamers.

While Dreamers in California are already eligible for Medi-Cal coverage, their federal designation as “not lawfully present” prevented them from being able to purchase a health plan through the state’s Covered California marketplace. The final rule, which will go into effect on November 1, 2024, addresses this by modifying the definition of “lawfully present” so that DACA recipients are no longer excluded. This will make them eligible to enroll in a Qualified Health Plan through the Health Insurance Marketplace or a Basic Health Program (BHP).

The Centers for Medicare and Medicaid Services (CMS) estimates that the rule could lead to 100,000 previously uninsured DACA recipients newly enrolling in health coverage through a marketplace plan or a BHP. As of March 31, 2022, 28% of the roughly 578,000 DACA recipients in the U.S. reside in California.

The California Medical Association and the American Medical Association (AMA) have supported extending the ability to purchase ACA marketplace coverage to Dreamers and advancing policies that address the unmet medical needs of unaccompanied undocumented minor children.

“Our country will become healthier and more equitable after the Biden Administration announced today it will expand health care access for Deferred Action for Childhood Arrivals (DACA), or Dreamers,” said AMA President Jesse M. Ehrenfeld, M.D., MPH. “The AMA knows that expanding access and advancing health equity improves population health and is likely to result in reduced costs for American taxpayers since individuals without insurance are less likely to receive preventative or routine health screenings and may delay necessary medical care, often resulting in higher health care costs down the road.”