Hi I got my Work Authorization through DACA in June 2014 and i was wondering if the penalties will apply to me. I have tried using covered california to get insurance only for them to tell me that i am not eligible because i am not of legal presence.


Answer

DACA recipients can't use the marketplace, and aren't required to pay the fee. Some state's allow Medicaid for DACA recipients.

In other words, DACA recipients are not eligible for health insurance under the Affordable Care Act (AKA DACA recipients are not eligible for ObamaCare and are "exempt" from its mandates). This is because they are not considered lawfully present for purposes of the Affordable Care Act. Therefore they do not have to pay the fee for having health insurance and can't get a marketplace plan with cost assistance.

DACA recipients can however still obtain health insurance through their employer, through the private market outside of the marketplace, or obtain Medicaid in some states that allow for it and use their own funding (this only applies to those recipients who meet the income requirements for Medicaid).

DACA recipients can take a "code C" exemption of form 8965 (see page 3) as per IRS guidelines (see question 11).

The final ruling on how Deferred Action for Childhood Arrivals (DACA) recipients are treated, in regards to the PPACA, can be found here:www.gpo.gov/fdsys/pkg/FR-2012-08-30/pdf/2012-21519.pdf

NOTE: In some states Deferred Action for Childhood Arrivals may be eligible for Medicaid. In these state's only state funding is used.

You can find everything you need to know about DACA recipients and ObamaCare from NILC.Org.

ACA-related federal regulations

♦♦ www.gpo.gov/fdsys/pkg/FR-2012-08-30/pdf/2012-21519.pdf ♦♦

  • Amends the definition of which immigrants are considered “lawfully present” for the high-risk pool (PCIP) by adding an exception for individuals granted deferred action through the DACA process. Individuals granted deferred action for other reasons will still be considered “lawfully present.”
  • Issued as an interim final rule, effective August 30, 2012. A 60-day comment period ended October 29, 2012. Comments can be viewed at www.regulations.gov/#!docketDetail;D=CMS-2012-0138.
  • Interim final rule adds exception for DACA to Title 45 of the Code of Federal Regulations section 152.2 (45 CFR § 152.2) definition of “lawfully present” for PCIP eligibility.
  • Other ACA rules reference the definition of “lawfully present” at 45 CFR § 152.2.
    • Final rule on eligibility for the health insurance marketplace references 45 CFR § 152.2 for definition of “lawfully present”; so DACA-eligible individuals are excluded from eligibility to enroll in the marketplace.
    • Final rule on Health Premium Tax Credit references 45 CFR § 152.2 for definition of “lawfully present”; so DACA-eligible individuals are excluded from premium tax credits (also referred to as Advanced Premium Tax Credit, or APTC).
    • Final rule on Shared Responsibility Payment for Not Maintaining Minimum Essential Coverage and related exemptions references 45 CFR § 155.20, which references 45 CFR § 152.2; so DACA grantees are exempt from the individual mandate.
    • Interim final rule indicates eligibility for cost-sharing reductions (CSR) will be the same as premium tax credits, as there is no rule on CSR yet.
    • Proposed rule on Basic Health Program (BHP) references 45 CFR § 152.2. Comments are due November 25, 2013.

Note we had to correct this answer a few times as information was sparse. The list above is from nilc.org.

Learn more on our page on Key Facts Regarding DACA Recipients and the Affordable Care Act.

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rends on


Answer Rating:

This answer is incorrect!!!

ObamaCareFacts.com on


Answer Rating:

What part of the answer is incorrect?

1. DACA recipients can’t use the Marketplace.
2. DACA recipients do have to pay the fee.
3. DACA recipients may be eligible for Medicaid and CHIP in 21 states that use their own funds to provide coverage to DACA recipients.

The thing about this is, it’s not covered under the law since it happened after the law. We actually are looking for community involvement to ensure that these answers all become 100% correct over time. So make sure to add comments, don’t just say something is wrong.

Dani on

I’m in Georgia. And I have a friend with DACA who’s pregnant (29 weeks already). And she have Medicaid.

ObamaCareFacts.com on

TO avoid confusion, DACA is deferred action for immigrants born in the U.S., Medicaid is a join federal-state public healthcare program for low income Americans expanded by the ACA (ObamaCare / Affordable Care Act).

If ObamaCare is repealed tens of millions will lose Medicaid if no other action is taken.

ObamaCareFacts.com on


Answer Rating:

We have updated our answer. DACA recipients DO NOT owe the fee.

Jose on

I did not know this before I filled my tax return and I paid the fee is there a way to record error the money?

ObamaCareFacts.com on

IRS should give you a refund.

Margaux Milchen on

I am a single member S-Corp which makes me an employee of my corp and I pay myself a paycheck. I go through the exchange and get a premium subsidy. This year I hired someone but they happen to be DACA (deferred action immigrant) and not eligable. Do I need to change anything since she is not eligable for insurance?

ObamaCareFacts.com on

As the owner of your small business you will get an individual health plan for yourself (not a group health plan). You don’t need to provide coverage to your employees. If you do decide to provide coverage you can do so under a group plan (for employees only). Someone with DACA status can be offered coverage and you can claim the tax breaks for offering coverage, but they can’t get tax credits on individual marketplace coverage.

Margaux S Milchen on

Actually, there are special rules for small sub chapter S corps..and if you are a single member with no employees, you may go through the exchange, but if you have a qualifying employee, you may not. My employee is not a qualified employee. I had to do research to figure this out. It has nothing to do with the 50 employee rule. This is a separate issue which had a clarifying ruling earlier this year. Thanks for your earlier help. I was referring to the IRS ruling 2015-17. Sorry, I wasn’t clear

Rena on

Does this still apply as of late? DACA recipients do NOT owe the fee?

ObamaCareFacts.com on

From what I understand this information is still current. You can always double check here: https://www.nilc.org/acadacafaq.html

With things like this, where we don’t have (and can’t get) personal experience, we always greatly appreciate when those who do leave a comment to confirm or correct anything on this page.

Ana on

Did this exemption apply for tax season of 2015? Because I am just now learning about it… and if it did, can I be refunded the penalty fee I paid for that year?

ObamaCareFacts.com on

As far as we are aware this still applies and applied in 2015. If you find any different information please share it, we are an independent site and not an official source of tax information. If the IRS took the penalty payment but didn’t need to, they should catch it and send a refund. You can follow up with them if needed.

ruth on

Is there a form that we have to file when doing our taxes to not pay the penalty?

Because I paid last year, and for what I am seeing I didn’t have to pay. I want to avoid any unnecessary charges this year.
Please help !

ObamaCareFacts.com on

It’s the 8965 form for exemptions. And 8962 if you got tax credits (just google them as needed). If you overpay in error the IRS should refund you.

Sara on

My husband was approved for DACA in October 2014 and has had it since then up until on January 21 2016, we had the interview for his green card and he was approved for it. Will we have to pay the fee? He still does not have insurance but has applied for our state insurance plan, HIP (Healthy Indiana Plan). We are in Indiana and I was born here (I’m a natural born citizen) and am covered with insurance, if that makes a difference.

ObamaCareFacts.com on

Call healthcare.gov, getting a green card could very well be a “qualifying life event” for special enrollment.

dan on

what if i am a self employe, i got a 1095 b i don’t know how? i live in ct.

ObamaCareFacts.com on

You only really need to deal with the 1095-A, as it helps for filing 8962 tax credit form. If you didn’t get tax credits just take the deductions related to health for self employed. 1095 only works as proof you had coverage to avoid the fee in your case.

Frank on

Hello!
So how do we go about getting this Exemption Certificate Number? To be honest I’ve been doing my my taxes without getting one for the past 2 years. I’ve heard the IRS could penalize me. I called the marketplace to ask if they could provide me one, they said I have to call the IRS directly to request one or I could get one where I get my taxes done. My tax guy doesn’t know anything about the exemption certificate number. Then I called the office where I get help renewing my DACA that also does taxes and they said that I have to call around to see if I can get the certificate number from a private doctor’s office. From my understanding, the form 8965 is to be sent along with your taxes so you don’t get penalized. Is that true? Any and all help be much appreciated.

Kim on

I have DACA and applied for the ACÁ. I recently found out. DACA are not eligible. So, I terminated coverage immediately. I never claimed to be a u.s citizen nor a green card holder.
I provided the work permit and the social security number. Why did it approve it if DACA holders aren’t supposed to have it?

ObamaCareFacts.com on

Very good question. I would assume it was a mistake.

I don’t want to go speculating too much here, but for another resource (and likely a safe place to call and ask information) see http://www.coveredca.com/individuals-and-families/getting-covered/immigrants/

cris on

Does CHIP Perinatal count as health coverage?

ObamaCareFacts.com on

If a parent is covered by CHIP then it counts as coverage unless it is a limited benefit plan. https://eligibility.com/medicaid/what-if-i-have-medicaid-now-but-i-have-only-limited-benefits