New Health Connector Eligibility for DACA Recipients

Overview

As of November 1, 2024, Deferred Action for Childhood Arrivals (DACA) recipients are considered lawfully present for Health Connector purposes. This allows DACA recipients to access subsidies (if they meet all subsidy eligibility requirements) and unsubsidized coverage options through the Health Connector.

Currently, DACA recipients up to 300% FPL are eligible for MassHealth Family Assistance. Individuals above 300% FPL will now be eligible for coverage through the Health Connector, if they meet all eligibility requirements.

The Health Connector will use a workaround approach to appropriately determine DACA recipients' eligibility. DACA recipients will be granted a Special Enrollment Period (SEP) and can enroll in coverage that starts as early as December 1, 2024. This SEP will be automatically granted by the daily workaround process described below.

High-Level Daily Workaround Process

• Starting on November 15, 2024, new applications submitted with DACA status, the results will show as “Not Eligible”.
• Overnight, the eligibility for any new applications and all existing applications previously denied for DACA statuses will be updated through the workaround process.
• If they are eligible for a Health Connector plan (i.e., they were not denied based on anything other than DACA status), they will be determined for the appropriate Health Connector benefit based on their FPL.
• They will receive an approval notice from the Health Connector after this update is completed. They will not receive a denial notice.
• They will have a SEP to shop and enroll for coverage beginning as soon as December 1, 2024, but can also enroll at any point during Open Enrollment for 2025 coverage.

Existing or New Applicants

DACA recipients may be confused and contact an Assister or the Health Connector because they have two conflicting eligibilities:

1. Not Eligible - before workaround and
2. Health Connector Eligible - once the workaround is in place

Assisters or Health Connector customer service staff members will need to review the current eligibility, explain the determination, and if they are eligible for a Health Connector plan, assist them with shopping for a plan. Below are talking points and actions to consider when helping existing or new applicants.

Existing Applicants:

• Existing applicants who have already applied for coverage through the Health Connector will be automatically picked up by the workaround on November 15, 2024.
• The Health Connector will redetermine their eligibility. If they are found to be eligible for a Health Connector plan (i.e., the only reason they were denied was due to DACA status), the member's eligibility will be updated by the workaround to the appropriate Health Connector benefit based on their FPL.
• They will receive an approval notice after this override is complete.
• They will have a SEP to shop and enroll for December 1, 2024, but can also enroll at any point during Open Enrollment for 2025 coverage.
• Applicants may contact an Assister or Health Connector customer service after receiving an approval notice and they will need to review the current eligibility, explain the determination, and help them shop for a plan.
• Assisters and Health Connector customer service staff should be proactive and advise of any potential RFIs.

Those Newly Applying:

• When helping anyone newly applying, they should complete their online application and select “DACA” status on the immigration screen.
• Based on the DACA status, the member will get a “Not Eligible” result on their eligibility results summary at the time of submission. However, they will not receive a denial notice.
• New applicants can start applying on November 1, 2024, but will not have their eligibility updated until November 15th. Applicants who apply on 11/15, or after, will be picked up in the daily workaround and have their eligibility updated the next day.
• If the reason for not being eligible is their immigration status (they have DACA status and are over 300% FPL they will be automatically determined ‘Not Eligible’ by the system).
• Any applicable RFIs (e.g., immigration, income, residency) will be generated after the update is complete. Members who have active RFIs will need to submit proof so that they can keep their coverage.

Report a Change Consideration 

Each time a DACA member reports a change, they will get the “Not Eligible” result on the eligibility results screen. They will not get a denial notice. They will get picked up in the daily workaround process and their eligibility will be updated as appropriate.