Treatment of U.S.

Citizens and Immigrants Under the Affordable Care Act

U.S. Citizens
Subject to Individual Mandate Eligible for Medicaid Expansion in States that Take Up the Option
Yes

Lawfully Present Immigrants

Yes Individuals with incomes < 138% of the FPL who have surpassed the fiveyear waiting period. Immigrants must be qualified. Yes; all non-pregnant adults subject to the five year waiting period; immigrant children and pregnant women have waiting period in states that do not elect CHIPRA state option. Not qualified immigrants are ineligible entirely. Maintains existing verification through Systematic Alien Verification for Entitlements (SAVE). Yes

Undocumented
No; Exemption determined during tax reconciliation No; undocumented individuals are not eligible for full-scope Medicaid. Lawfully present DACA recipients are ineligible.

Individuals with incomes < 138% of the Federal Poverty Level (FPL)

Waiting Period for Medicaid

No

Ineligible for full-scope Medicaid. Lawfully present DACA recipients are also ineligible.

Verification for Medicaid

Maintains existing verification requirements via Social Security Administration (SSA), including documentation of citizenship and identity requirements. Yes

Ineligible for full-scope Medicaid No; undocumented immigrants cannot purchase insurance through the exchange No explicit ban

Access to Individual Exchanges Access to Small Business Health Options Program (SHOP) Verification System Used for Exchange

Yes Citizenship verified with SSA. Citizenship documentation is used as secondary verification resource or alternative Yes; Modified Adjusted Gross Income (MAGI) must be > 100% of the FPL.

Yes Legal presence determined through federal data hub used by all states. Additional documentation proof often required. Yes; MAGI must be between 100 and 400% of FPL. If under 100% of FPL, legal immigrant must be ineligible for Medicaid due to statutory restrictions. Household MAGI and total household size both count toward calculation of tax credit

Ineligible for the individual exchange

Eligible for Tax Credits and Affordability Help

No

Rules for Determination of Federal Poverty Level (and Subsequent Eligibility for Tax Credit)

Household MAGI and total household size both count toward calculation of FPL

Household size and income are adjusted, so that lawfully present immigrants and U.S. citizens receive a comparable tax credit allocation to other households