Activist ToolKit

Deferred Action for Childhood Arrivals

Comment Submission Guidelines

The U.S. Department of Health and Human Services (HHS) have issued an Interim Final Rule excluding those granted Deferred Action for Childhood Arrivals (DACA) from expanded coverage options under the Affordable Care Act. This, in conjunction with August 28, 2012 Guidance from the Centers for Medicare and Medicaid Services (CMS) prohibiting states from using federal funds to provide health coverage to pregnant immigrant women and immigrant youth under 21 years of age under the Children’s Health Insurance Program Reauthorization Act, will dramatically restrict access to health care forindividuals who came the United States as children. HHS has opened this Interim Final Rule to the public for comment. Comments are due at 11:59 PM Eastern Time (ET) on Monday, October 29, 2012. Please read below about how you can express your opposition to the rule and urge HHS to remove this harmful rule.

Read Up on the Issue

  • Fact Sheet from National Latina Institute for Reproductive Health
  • Fact Sheet from the National Immigration Law Center

Things to Consider Before Submitting Comments

  • All comments you post will be open to the public, so do not share any information that you do not want public. Please review the Privacy Notice, but recognize that you are submitting your information to the government for public purposes.
  • Be sure to identify your interest in this issue.
  • But do share your story!

Content for your Comments

Considering discussing how the Interim Final Rule….

  • Undermines Coverage for Immigrants, Who Already Face Barriers to Care: The individuals who may be granted deferred action under DACA are between the ages of 15 and 30, and live predominately in states such as California, Texas, New York, Illinois, and Florida, which have among the highest number of uninsured residents. Many of the uninsured live in low-income, working families, with parents working in industries where employers do not offer health coverage. They are likely to be among those who do not have a regular source of care due to their income, insurance, and immigration status. Individuals granted deferred action under DACA would have had new options for affordable health insurance and could have benefited under the ACA, Medicaid, and CHIP but for this amendment.
  • Will Drive Up Costs: The Interim Final Rule excludes DACA individuals who are healthier and younger than the general population from the newly created health insurance risk pools in the exchanges. By increasing the number of young and healthy individuals who enter the insurance pool, insurers are able to reduce the health insurance premiums for all.Their participation would drive down costs.
  • Will Restrict Access to Reproductive and Sexual Health Care for Women: The Interim Final Rule, in conjunction with the CMS Guidance, leaves immigrant women with very few options for affordable and quality health coverage of important reproductive and sexual health care. Immigrant women deserve and need access to reproductive and sexual health care in order to plan and space their pregnancies, prevent and treat sexually transmitted infection (including HIV), prevent gynecological cancers. Immigrant women also deserve access to full coverage of important pregnancy-related care, including prenatal and postpartum. Access to preventive care, prenatal care, and postpartum care are cost-effective and improve health care outcomes for women.
  • Will Lead to Higher Costs, Poorer Health Outcomes: Due to the Interim Final Rule, DACA recipients will remain without a regular source of care and instead will need to rely on already-strained safety net systems like community health centers and Title X family planning clinics, and expensive emergency room care. As a result, health care costs for these individuals, as well as costs to the overall health care system, will remain high and could lead to poor health outcomes and increased health disparities.
  • Will Create Confusion: Instead of creating a more streamlined eligibility and enrollment system under the ACA, the Interim Final Rule will introduce additional complexity in eligibility rules and confusion for state agencies, eligibility workers, and patient navigators. The exception will exacerbate the confusion as states reach out to immigrant communities to encourage them to enroll. States will now have to train patient navigators, consumer assistance programs, and eligibility workers about the distinction between those granted deferred action under the DACA process and those granted deferred action on other grounds.
  • Is Arbitrary and Unnecessary: It is unreasonable and unfair to distinguish between individuals granted deferred action through the DACA process and individuals granted deferred action for other reasons. Since this population was granted a form of relief already considered by HHS and other agencies to be “lawfully present,” the decision to exclude these particular individuals from eligibility is arbitrary and unnecessary.
  • Undermines the goals of health reform: The August 30th Interim Final Rule runs counter to one of the primary goals of health reform – to expand access to affordable health coverage to millions of currently uninsured individuals. The amendment to exclude individuals granted deferred action under the DACA process from those considered “lawfully present” under the ACA eliminates access to affordable coverage for vulnerable, uninsured individuals.
  • Will Limit Opportunity, Sends Mixed Messages:The DACA program ensures that eligible individuals can live in the United States without fear of deportation, and that they are able to work with authorization so that they might provide for themselves and their families. In order to ensure that they are healthy and productive at work, these individuals need access to affordable health insurance. Despite the recognition of these individuals’ circumstances, the Interim Final Rule sends a mixed-message by allowing them the opportunity to work and at the same time preventing them from buying health insurance, thereby undermining their ability to participate and contribute fully to the economy and to their communities.

Be Sure to Include

For the reasons discussed below, we recommend deletion of subsection 8 of 45 CFR § 152.2, effective immediately.(8) Exception. An individual with deferred action under the Department of Homeland Security’s deferred action for childhood arrivals process, as described in the Secretary of Homeland Security’s June 15, 2012, memorandum, shall not be considered to be lawfully present with respect to any of the above categories in paragraphs (1) through (7) of this definition.

How to Submit Your Comments to HHS:

  • Please remember the due date is Monday, October 29 at 11:59 Eastern Time. Please make sure to account for time zone differences.
  • To submit electronically:
  • Go the Comments Submission Page, Click on “Comment Now!”
  • If the above link does not work, please follow the below instructions
  • Go to
  • Enter “CMS–9995–IFC2” into the Search Box on the Main Page
  • Click on “Comment Now!”
  • You will now be taken to the main page to enter your information and comments
  • Step 1: Enter Information: Please review the Privacy Notice.
  • Please note that First Name, Last Name, City, and Organization are not required
  • Country, State/Province/Postal Code ARE required
  • You will also need to click on the “Category” that you pertain to. You can indicate if you are a medical professional, lawyer, or individual. Please click the category that pertains to you.
  • Step 2: Type Comments: Please note that this option is for comments 2000 characters or less. If your comments exceed 2000 characters, please type them out onto a word processing document (like Word), save to your computer and then upload utilizing the “Upload File” Option.
  • Step 3: Upload your comments
  • Submit: Submit your comments by pressing the “Submit” button. If you would like to preview before submitting, please press “Preview Comment” before submitting.

Stay Posted for Updates!Please stay posted for updates from the National Latina Institute for Reproductive Health for how else you can take action to reverse this decision! For more information, please contact Natalie D. Camastra at or (202) 621-1434.

NATIONAL LATINA INSTITUTE FOR REPRODUCTIVE HEALTH

50 Broad Street, Suite 19371901 L Street, NW, Suite 300

New York, NY10004Washington, DC 20036

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