Hey, whatever happened to CMS letting DACA recipients enroll in ACA exchange plans anyway?

Back in April, the Associated Press reported that the Biden Administration planned on opening up eligibility for ACA exchange, Basic Health Program, Medicaid & CHIP coverage to hundreds of thousands of Americans who have Deferred Action of Childhood Arrivals status:

President Joe Biden is set to announce that his administration is expanding eligibility for Medicaid and the Affordable Care Act’s health insurance exchanges to hundreds of thousands of immigrants brought to the U.S. illegally as children, according to two U.S. officials briefed on the matter.

The action will allow participants in the Obama-era Deferred Action for Childhood Arrivals program, or DACA, to access government-funded health insurance programs. The officials spoke on the condition of anonymity to discuss the matter before the formal announcement on Thursday.

As I noted at the time:

There's roughly 580,000 immigrants who have DACA status as of today. While all of them would presumably become eligible for ACA enrollment (and, therefore, federal ACA subsidies) via the change in their residency status, that doesn't mean 580K new ACA exchange enrollees. According to the Kaiser Family Foundation, around 39% of them are currently uninsured, or roughly ~230,000, give or take. The rest have other types of healthcare coverage just like most other Americans do.

Even among those ~230K, not all of them will necessarily qualify for financial subsidies as some may have too high an income, although I suspect that number will be minimal among this population. And of course some of them will become eligible for Medicaid instead. On the other hand, some of the other ~350K DACA recipients who are currently categorized as "insured" may have terrible coverage via short-term or other types of "junk" plans and thus may become eligible for ACA/Medicaid coverage as well.

Sure enough, the Centers for Medicare & Medicaid Services made it official a few weeks later:

HHS Releases Proposal to Expand Health Care for DACA Recipients

WASHINGTON, D.C. – The Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), today released a notice of proposed rulemaking (NPRM) that, if finalized, would expand access to health care by reducing barriers for Deferred Action for Childhood Arrivals (DACA) recipients. Earlier this month, HHS announced its intention to release this rule by the end of April, and today’s announcement marks the fulfillment of that promise. The proposed change applies to the Health Insurance Marketplaces, the Basic Health Program, and some Medicaid and Children’s Health Insurance Programs (CHIP).

...The proposed rule, if finalized, would remove the current exclusion that treats DACA recipients differently from other individuals with deferred action who would otherwise be eligible for coverage under select CMS programs. If the rule is finalized as proposed, it could lead to 129,000 previously uninsured DACA recipients receiving health care coverage. Over the last decade, DACA has provided peace of mind and work authorization to more than 800,000 Dreamers.

The proposed rule would amend the definition of “lawfully present” to include DACA recipients for the purposes of Medicaid and CHIP. In effect, this would extend Medicaid and CHIP coverage to children and pregnant women in states that have elected the “CHIPRA 214” option for children and/or pregnant individuals, the Basic Health Program, and Affordable Care Act Marketplace coverage. DACA recipients would need to meet all other eligibility requirements to qualify for coverage. Additionally, DACA recipients would be eligible for financial assistance through the Marketplace, such as advance payments of the premium tax credit and cost-sharing reductions if they meet all other eligibility requirements.

This NPRM has a proposed effective date for all provisions of November 1, 2023. CMS is requesting comment from the public on proposed regulations, and specifically on the feasibility of this date and whether to consider a different effective date.

I concluded by noting that "the only remaining question appears to be whether Nov. 1st is the best time to make it official."

Well, November 1st, 2023 has come and gone...and unless I missed a press release, the proposed rule still hasn't been finalized, and DACA recipients still aren't considered to be "lawfully present" for purposes of enrollment in ACA exchange plans, BHP plans, Medicaid or CHIP. If anyone can confirm or correct me on this I'd be happy to post an update.

UPDATE (of sorts): I've received confirmation from a trusted source who wishes to remain anonymous that unfortunately the odds are against the DACA enrollment rule being finalized/implemented before the end of the 2024 Open Enrollment Period.