With limited exceptions, undocumented residents and recent green card holders are not eligible for federally funded health insurance programs (e.g., Medicaid and Medicare). However, in order to provide health care to those in need regardless of immigration status, the District of Columbia created two locally funded health insurance programs: the Immigrant Children’s Program (ICP) and the DC Health Care Alliance (the Alliance). There are no monthly premiums, copayments, or other charges for covered services for the Alliance and ICP.
Eligibility and Application Requirements
The Immigrant Children’s Program is available to District residents who are 20 years old or younger and have family income at or below 319% of the Federal Poverty Line (for children up to age 18) or up to 216% of the Federal Poverty Line (for ages 19-20). DC Health Care Alliance is available to District residents who are 21 years old or older, have income at or below 200% of the federal poverty level, only have financial assets (a bank account, for example) at or below $4,000 for a single applicant and at or below $6,000 for couples and families, have no other health insurance, and are not eligible for Medicare or Medicaid.
District residents can apply for the DC Health Care Alliance through the Combined Application for Benefits and must complete an interview in person or by phone. Participants must re-certify their enrollment once a year. District residents can apply to the Immigrant Children’s Program online or in person.
Impact of the Alliance and ICP
Unsurprisingly, people with health insurance tend to have diseases diagnosed sooner, receive more consistent care, have better health outcomes, and live longer than people without health insurance. Furthermore, access to health insurance enables people to treat their chronic conditions, such as diabetes and asthma, so they’re less likely to wind up in the emergency room. This is beneficial for those with chronic conditions and can save the government money on emergency costs and reduce wait times at hospitals for everybody in need of emergency services.
In the District, where 44% of residents who don’t have US citizenship are Latine, 16% are Black, and 18% are Asian American, lapses in health care access for immigrants is likely to disproportionately impact people of color. Because eligibility for the Alliance and ICP is based on a combination of immigration status and income, determining how many eligible DC residents are still not being served poses major challenges since many immigrants without legal status prefer to remain anonymous to government data collection.
Funding and Participation
The District’s FY25 budget includes $132.6 million for Alliance and $18.3M for ICP provider services. As of November 2024 (the most recent available data), the Alliance enrolls 26,370 District residents and ICP enrolls 5,871 District residents. Enrollment has shifted significantly over the past few years, increasing – like all public health insurance programs – during the COVID-19 public health emergency, because from 2020-2022 the District removed almost no residents from either program, removed certain enrollment barriers, and allowed new people to join. In August 2022, enrollment plummeted to pre-pandemic levels when annual recertification processes resumed. The programs have now returned to high participation numbers – higher than peak pandemic enrollment – thanks in part to enrollment reforms, more programmatic awareness among eligible populations, and an increase in immigrants making the District their home.
Recommendations
The District took a vital step to strengthen the Health Care Alliance by extending its recertification period to 12 months and removing the requirement for in-person enrollment interviews. These recent changes should be preserved. With increased federal threats to immigrant communities, we recommend that the District continue to fund, champion, and promote the Alliance and ICP to help all District residents access health care.
