Health Reform Issue Brief: Immigrants and the Affordable Care Act, National Alliance of State and Territorial AIDS Directors (NASTAD) (2014)

The National Alliance of State and Territorial AIDS Directors (NASTAD) represents state health agency staff with programmatic responsibility for administering government-funded HIV health care and services. With capacity building as one of its organizational priorities, NASTAD regularly publishes and disseminates resources to “strengthen state and territory-based leadership, expertise, and advocacy.” This issue brief provides information about the Affordable Care Act (ACA) and its effect on immigrant populations regarding access to HIV and viral hepatitis health care programs.

The issue brief outlines how several major ACA provisions will have a significant impact on immigrant populations. For example, in states that opt to expand Medicaid, immigrants residing in the United States for at least five years may have access to Medicaid if they are at or below 138% of the Federal Poverty Level. Similarly, immigrants that meet the five-year residency requirement may be eligible for premium tax credits or cost-sharing reductions in the Qualified Health Plan Marketplace based on their income level. There may be additional options from community health centers and public health programs.

These changes are significant because immigrants face particular healthcare barriers due to high poverty levels, high rates of uninsured individuals, and communities disproportionately affected by HIV (particularly Latino communities). The ACA will maintain the distinction between lawfully present immigrants and those “not lawfully present.” As a result, the new healthcare opportunities are not available for undocumented immigrants. However, undocumented immigrants that submit application information for health care program eligibility will have no risk of deportation proceedings or other adverse action from the Immigration and Customs Enforcement Agency.