open enrollment

Starting this Friday, approximately 7,000 DACA recipients in Maryland will gain access to the state’s health insurance marketplace during the open enrollment period, contributing to a larger national pool of over 100,000 newly eligible immigrants across the United States.

This significant policy shift stems from a decision made by the U.S. Department of Health and Human Services back in May, which expanded eligibility for Affordable Care Act (ACA) coverage to encompass individuals protected by the Deferred Action for Childhood Arrivals (DACA) program. This program, established during the Obama administration, offers a safeguard against deportation for undocumented immigrants who were brought to the U.S. as children.

Many immigrant advocates view this transformation as a long-overdue necessity and assert that further initiatives are required to encompass additional immigrant populations within the health insurance marketplace in Maryland. George Escobar, the chief of programs and services at the immigrant advocacy organization CASA, expressed his “overjoyed” sentiments regarding the recent decision, highlighting the urgency of this change.

“This is something that should have been done from the beginning,” he noted. “It’s been a long time coming.”

Michele Eberle, the executive director of Maryland Health Connection, which oversees the state marketplace, expressed optimism that the integration of DACA recipients, along with recent outreach efforts targeting young adults, will further build upon last year’s record-breaking enrollment statistics.

“We’re hoping to reach more people than ever,” Eberle stated. “My anticipation is that we’re going to have a really smooth open enrollment and that we will get more people covered into affordable, quality health care coverage.”

Last year, a historic 213,895 residents of Maryland enrolled in the state health marketplace, and that figure has since climbed to 216,371 as of September, the latest reporting period. With about 6.3% of Marylanders lacking health insurance in 2023, as reported by KFF Health, this represents a promising drop compared to the national uninsured rate of 7.9% for the same year.

The annual open enrollment period for the state’s health insurance exchange launches this Friday and will continue through January 15. Throughout this time, residents of Maryland will have the opportunity to explore various affordable health care options for themselves and their families or to modify their existing insurance plans.

In an important policy update, HHS redefined the term “qualified noncitizen” eligible for Affordable Care Act benefits, now including around 100,000 DACA recipients across the nation. While some DACA recipients may already possess health coverage through employer-sponsored plans, George Escobar underscores that many of them are “under-employed,” meaning they often hold part-time positions that do not offer health care benefits.

For those without access to ACA marketplace insurance, choices for adequate health care coverage have been markedly restricted, as previous regulations barred them from obtaining any benefits associated with Obamacare, according to Escobar.

“Through this new rule change that HHS has promulgated, it opens up DACA as an eligible immigration status that would allow them to access into the marketplace now,” he articulated. “And more importantly, eligible for subsidies that make those plans affordable.”

While the exact number of DACA recipients who will enroll through Maryland Health Connection remains uncertain, Escobar affirmed that CASA is diligently working to disseminate information to those eligible who currently lack job-based health care coverage.

“This is a completely new change,” Escobar emphasized. “So our first priority is to inform the eligible community that this opportunity exists for them. So, out of those 7,000, it is really difficult to know how many folks will actually enroll.”

Undocumented immigrants who do not fall under DACA protections will still be excluded from purchasing health insurance within the state’s marketplace this year. However, changes are on the horizon, as a state law passed allows for more comprehensive access in 2026 through the Access to Care Act, enabling undocumented Maryland residents greater opportunities to obtain private health care coverage outside of the state’s insurance marketplace.

Escobar contended that ensuring universal access to health insurance, regardless of immigration status, represents a crucial step in bolstering protections for Maryland’s immigrant communities.

“Immigration status should not be an obstacle to obtaining coverage or having access to a primary doctor,” Escobar asserted. “We cannot be in a position where the public health system is set up to create winners and losers and select who has access and who doesn’t. Universal access is the only way in which we can really create a strong public health system that’s going to benefit us all.”

He acknowledged that the recent change allowing DACA recipients access to the marketplace is a significant yet incremental advancement toward comprehensive healthcare coverage for all.

Young adult subsidies to health plans

Eberle noted that the inclusion of DACA recipients in the forthcoming open enrollment period could potentially aid in covering some of the 6% of Maryland residents who remain uninsured. Additionally, she aspires to further diminish the state’s uninsured rate by actively engaging and recruiting young individuals to participate in the insurance marketplace.

According to data from the Maryland Health Benefit Exchange (MHBE), young adults aged 18-37 account for approximately 42% of those lawfully present individuals who are non-Medicaid eligible and uninsured in the state.

A 2021 legislative initiative introduced a pilot program providing health insurance subsidies specifically for young adults, aimed at making healthcare more affordable. This program has received an extension, now running through 2025.

“We know that everyone is sensitive to the price around health insurance…but particularly for younger individuals – individuals who might have less income coming into their family,” Eberle explained. “They may be more willing to take a risk, may not feel the need to have health insurance.”

The pilot program offers those between the ages of 18 and 37 a sliding-scale subsidy for health insurance plans available on the exchange. The average subsidy has resulted in a monthly premium reduction of $38 per member for 2024.

Since the inception of these subsidies in November 2021, youth enrollment in the exchange has surged by an impressive 46%. As a result, over 57,000 young adults are benefiting from the state’s subsidies for healthcare plans in 2024, according to data from MHBE.

Eberle characterized the youth subsidy program as a “huge success,” further noting that some members of the General Assembly are currently contemplating making the program a permanent fixture in the upcoming 2025 session.

“Once people get health coverage and understand all of the wellness benefits and preventative benefits…the things that are built into insurance – there’s value there,” she remarked.