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Pre-existing Condition Insurance Plan (PCIP) eligibility clarification

U.S. born undocumented residents under 30 do not become eligible based on recent action by Homeland Security

August 30, 2012 - The U.S. Department of Health an Human Services issues clarifying proposed regulations regarding eligibility for the Pre-existing Condition Insurance Plan. The intent is that eligibility for the program will not expand due to recently changed policy by the Department of Homeland Security in who is a lawful resident. The new regulation primarily affects individuals under age 30 who were born in the U.S. as children of undocumented residents. It states "An individual is eligible to enroll in a PCIP if he or she: (1) Is a citizen or national of the United States or is lawfully present in the United States (as determined in accordance with section 1411 of the Affordable Care Act /1/); (2) has not been covered under creditable coverage (as defined in section 2701(c)(1) of the Public Health Service Act as of the date of enactment of the Affordable Care Act--that is, March 23, 2010) during the 6-month period prior to the date on which he or she is applying for coverage through the PCIP; and (3) has a pre-existing condition, as determined in a manner consistent with guidance issued by the Secretary of HHS. We further provided in SEC 152.14(a)(4) of the interim final rule that an individual must be a resident of a state that falls within the service area of the PCIP". See the entire proposed regulation here.

Other commercial insurance alternatives are available to undocumented residents. See the OnlineAdviser guidance titled "Health insurance without a social security number" or request OnlineNavigator service for personal help locating available options.