Deferred Action for Childhood Arrivals (DACA) recipients can now apply for health coverage through HealthCare.gov and individual state marketplaces. Here’s a guide for accessing care through New York State’s Essential or Qualified Health Plans.
Mike Wren/Department of Health
A scene from a NYS Dept. of Health tour of health care providers in 2022.
On May 3, President Joe Biden announced a change in the definition of “lawfully present” in its eligibility criteria for coverage under the Affordable Care Act (ACA), created by former President Barack Obama.
With the change, Biden announced the extension of medical coverage to Deferred Action for Childhood Arrivals (DACA) recipients to enroll in the ACA, which the White House anticipates will help more than 100,000 people obtain health insurance. DACA recipients—a status granted to certain immigrants who arrived in the country before the age of 16, resided here continuously and have no criminal record—can now apply for coverage through HealthCare.gov and individual state marketplaces.
In New York, the change meant that DACA recipients became eligible for either the state’s Essential Plan (beginning Aug. 1) or the Qualified Health Plan (QHP) beginning Nov. 1 (this is the individual market Open Enrollment Period in most states, which runs from Nov. 1 to Jan. 31. Coverage will begin on Jan. 1, 2025, if an individual enrolls by Dec. 15, or on Feb. 1, 2025, if later.)
The Essential Plan is low-cost or no-cost insurance for low-income adults who don’t qualify for Medicaid, the public health insurance program for people with low incomes, and is open year-round. The expansion of Essential Plan eligibility in New York to DACA beneficiaries was approved as part of New York’s Section 1332 waiver.
Qualified Health Plans are more comprehensive and come with higher costs than the Essential Plan, are available to a wider range of incomes and are offered through the New York State of Health (NYSOH) marketplace.
According to the New York State Department of Health, over 8,500 DACA recipients with incomes up to 250 percent of the Federal Poverty Line (FPL) have enrolled in the Essential Plan since it opened on Aug. 1.
City Limits created this guide on how DACA beneficiaries can apply for these healthcare plans, based on information shared by after the Department of Health.
Who’s eligible for the Essential Plan and Qualified Health Plan?
To be eligible for the Essential Plan, all New Yorkers—including DACA recipients—must have an income below $37,650. If their income is higher, the person would be eligible for a Qualified Health Plan and premium tax credits.
| Household Size | Maximum income |
| 1 | $37,650 |
| 2 | $51,100 |
| 3 | $64,550 |
| 4 | $78,000 |
In addition to having a strict cap on income level to qualify for the Essential Plan, both plans have similar requirements: To enroll, individuals must live in New York, be 19 to 64 years old, and be a U.S. citizen, national, lawfully present immigrant, or DACA recipient.
How to apply?
A spokesperson for the NYS Department of Health explained that DACA beneficiaries—and everyday New Yorkers who qualify—can enroll in these plans in one of three ways:
What documentation is required?
Applicants should be prepared to provide household members’ dates of birth, household income, and immigration status. For DACA recipients, the immigration documents required are their Employment Authorization Document (EAD) and I-797 Notice of Action.
If information cannot be verified electronically, a Health Department spokesperson explained, paper documentation may be needed.
Upon submission of the completed application (a video on how to submit the documents is here), applicants will receive an eligibility determination, and then will have the opportunity to select a health plan. In some cases, the spokesperson explained, the individual will be conditionally enrolled while awaiting documentation.
On average, it takes 45 minutes to complete the application.
Are there any membership fees, monthly fees, or premiums?
The Essential Plan has a $0 monthly premium for those who qualify, no deductible, and very low cost sharing.
A Qualified Health Plan may include Premium Tax Credits, which vary based on income and where the person lives. You can see which plans are eligible for a tax credit by using the Compare Plans and Estimate Cost tool.
For Qualified Health Plans, the price you pay each month will depend on the plan you pick. Most people are eligible for tax credits that lower their monthly cost. Tax credits are calculated based on your income, household size, and where you live.
| Annual Income | Tax credit |
| $38,000 per year | $751 |
| $45,000 per year | $657 |
| $50,000 per year | $598 |
| $60,000 per year | $458 |
What do I if I’m a victim of scams?
Scams increase during open enrollment periods. The Office of the Attorney General (AG) launched a consumer alert so that people do not pay to enroll or renew health insurance, do not fall for threats from supposed government agencies demanding payments, or asking for credit card information in a text message, email, or phone call.
“Many websites will try to fool residents into thinking that they are the official New York State Health Insurance Marketplace,” reads the AG alert. “There is only one official NY State of Health website. Submitting contact information to some websites may result in calls, texts, or emails from scammers.”
Any New Yorker who suspects that they are a victim of a scam is encouraged to report it to OAG by submitting a complaint online or calling 1-800-771-7755.
Launched in 2019, City Limits’ “What You Need to Know,” series aims to provide New York’s immigrant and Latino communities with practical information and explainers on a variety of topics. A Spanish-language version of this piece is forthcoming.
Is there an issue you think we should tackle next? Please send your suggestions to Daniel@citylimits.org
To reach the reporter behind this story, contact Daniel@citylimits.org. To reach the editor, contact Jeanmarie@citylimits.org
