Colorado: Over 5,700 undocumented immigrants have enrolled in health insurance coverage via OmniSalud

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One of the most inane restrictions of the ACA in my view, as I noted in my "If I Ran the Zoo" wish list back in 2017, is that it doesn't allow undocumented immigrants to enroll in ACA marketplace health plans ("Qualified Health Plans" or QHPs).

I don't just mean that they aren't eligible for federal financial subsidies--that's a prohibition which I can at least understand, even if I don't agree with it. I mean that they aren't allowed to enroll in ACA exchange-based QHPs even at full price, as noted in Section 1312(f)(3):

(3) Access limited to lawful residents.--If an individual is not, or is not reasonably expected to be for the entire period for which enrollment is sought, a citizen or national of the United States or an alien lawfully present in the United States, the individual shall not be treated as a qualified individual and may not be covered under a qualified health plan in the individual market that is offered through an Exchange.

Again, this doesn't just mean that they can't get federal financial help; it means they can't enroll via ACA exchanges at all:

Undocumented immigrants aren’t eligible to buy Marketplace health coverage, or for premium tax credits and other savings on Marketplace plans. But they may apply for coverage on behalf of documented individuals.

On the surface, this may not sound like that big of a deal--after all, most ACA individual market policies (QHPs) are also available off-exchange (directly via the health insurance carriers or via private brokers). In some cases these are identical to the on-exchange plan in terms of coverage, provider network, formulary, co-pays and so forth; in other cases there are slight variants. ACA-compliant off-exchange plans are still regulated exactly like on-exchange plans (no annual/lifetime benefit caps; the same maximum out-of-pocket costs; and so forth).

While off-exchange enrollment data is a lot harder to pin down than on-exchange enrollment, last fall I estimated that there were somewhere between 2.3 - 3.0 million Americans enrolled in off-exchange ACA-compliant individual market policies.

For the most part, the only difference between on-exchange and off-exchange plans is that you have to enroll on-exchange in order to be eligible for federal ACA premium tax credits and/or cost sharing reduction assistance...and since undocumented immigrants aren't eligible for those anyway, you might wonder why there'd be any advantage to them enrolling on-exchange?

Well, there's actually several reasons:

  • To avoid marketing/eligibility confusion: Every fall during the annual Open Enrollment Period, both the federal and state-based ACA exchanges launch big marketing/awareness campaigns urging Americans to visit HealthCare.Gov (or their state exchange) and #GetCovered. If you're an undocumented immigrant, you may do just that, only to discover that you're not eligible to enroll at any price, which no doubt confuses, upsets and discourages people. This may even lead them not to bother trying to enroll in an off-exchange ACA plan since they may falsely assume it means they aren't eligible to enroll in those either.

It’s important to understand that if you’re lawfully present, you can enroll in a plan through the exchange even if some members of your family are not lawfully present. Family members who aren’t applying for coverage are not asked for details about their immigration status. And clarifies that immigration details you provide to the exchange during your enrollment and verification process are not shared with any immigration authorities.

  • To be eligible for state-based financial help: While the ACA prohibits federal ACA financial subsidies from being provided to undocumented immigrants, some states may choose to do so. This is already the case when it comes to Medicaid: California pays for Medi-Cal coverage for hundreds of thousands of undocumented immigrants themselves without any federal funding.

In short, there's really no logical reason I can think of, even from a "xenophobic/federal fiscal policy" POV, to prohibit undocumented immigrants from at least enrolling in on-exchange ACA plans (as long as they aren't receiving federal financial help to do so).

All of which brings me to the point of this blog entry. Via Connect for Health Colorado:

Thousands of Coloradans Are Enrolling in Health Insurance Coverage Through OmniSalud

DENVER— For the first time ever in Colorado, people who are undocumented, as well as DACA recipients, have a safe way to enroll in affordable health insurance plans and qualify for financial help. The new program that makes this possible is known as OmniSalud, and it launched with the start of this year’s Open Enrollment season on Connect for Health Colorado’s new platform, Colorado Connect.

Since November 1, more than 5,700 people have used the program to enroll in a health insurance plan, and approximately 5,600 of those who have enrolled so far have qualified for state-funded financial help that reduces the cost of plans to $0.

Connect for Health Colorado’s Chief Executive Officer, Kevin Patterson, released the following statement:

“I’m elated by the early interest we’ve seen in OmniSalud. We know that if you or someone in your family is undocumented, you haven’t had good options to manage your health without health insurance. That’s why we’re so grateful that we could implement this innovative program for Coloradans using our new platform, Colorado Connect. For those who are considering applying, I urge that you make an appointment with an enrollment specialist as soon as possible. We have Brokers and Assisters who are ready to guide you in the enrollment process, advise you, and address any concerns and questions you may have.”

Immigrants and their families who need assistance enrolling, or who wish to learn more about the OmniSalud Program and speak with a certified expert, can find help by visiting here.

I'm not sure how the OmniSalud program flew below my radar; I wrote about a similar program in Washington State back in May, but at the time I didn't realize that Colorado was also implementing what sounds like a nearly identical policy as well.

In any event, this is good news on two fronts--both the fact that it allows undocumented immigrants to enroll in ACA coverage and that it provides extremely generous financial assistance to those enrollees.

Mazel Tov to Colorado!