Open enrollment for Covered California, the state’s health care marketplace, ended on January 31 with a record 1.98 million enrollees. For the first time, some “Dreamers”—undocumented immigrants who arrived as children—are able to enroll, due to a policy implemented by the previous presidential administration. While a court ruling has blocked Dreamers’ access to health care marketplaces in 19 states and a proposed federal rule change would block access nationally, for now California has gone in the other direction, creating a special open enrollment period that extends Dreamers’ timeline to purchase coverage. This and other recent changes have significantly expanded eligibility for health insurance among undocumented immigrants in California.

Established in 2010 as part of the federal Affordable Care Act, Covered California allows individuals to purchase private health insurance, often with public subsidies. Over time, its role in the state’s insurance landscape has grown.

In 2020, California became the first state to invest in subsidies to middle-class purchasers, and the federal government enhanced aid during the pandemic. Unless this policy is extended beyond 2025, subsidies will revert to assisting the core low-income population, with lower enrollments and higher premiums expected. Still, eligibility has expanded in other ways. In 2022, for example, a federal change eliminated the “family glitch” by extending subsidy eligibility to some previously excluded dependents.

Numbering around 760,000, Dreamers make up a small proportion of California’s large foreign-born population, which includes naturalized citizens as well as documented and undocumented immigrants. Under the new federal change, only Dreamers who are recipients of Deferred Action for Childhood Arrivals (DACA) may purchase health insurance through Covered California. Over 150,000 DACA recipients live in California, the most of any state, and an estimated 40,000 could be eligible for Covered California. Though they arrived as children, the average DACA recipient nationally is 30 years old.

Though not all Dreamers are affected, looking at the demographics of Dreamers in California provides insight into the population that could be newly eligible to purchase through Covered California. Compared to immigrants overall, Dreamers are more likely to be male (54% vs. 48%) and Latino (75% vs. 48%), and less likely to be Asian (16% vs. 34%) or white (6% vs. 14%). About 80% of Dreamers are attending school or working—and roughly 200,000 of this group lack health insurance. Unlike immigrants overall, who tend to have private plans, insured Dreamers are about as likely to have Medi-Cal (39%), California’s Medicaid program for low-income residents, as they are to have private coverage (36%).

It is important to note that not all Dreamers are eligible for DACA, which grants qualifying Dreamers a renewable two-year residency and work permit, and DACA recipients are still undocumented immigrants. Roughly one-third of Dreamers in California appear to meet DACA criteria, though far fewer are DACA recipients. Following a legal ruling in January, new DACA applications are being not processed, though existing DACA status remains valid.

In recent years, two other changes in health insurance eligibility have also affected DACA recipients. Last year, California expanded eligibility for Medi-Cal to all low-income Californians, regardless of immigration status. Additionally, DACA recipients with incomes too high to qualify for Medi-Cal but who lack access to affordable employer coverage can now purchase insurance through Covered California, potentially receiving financial assistance in the form of premium tax credits or cost-sharing reductions to reduce their out-of-pocket costs.

The federal health policy landscape is highly uncertain, with many priorities in health coverage and care in flux. California continues to chart its own course to reflect the state’s priorities within legal parameters. If the policy change to include DACA recipients in marketplaces remains in place, it will help bring California closer to its goal of universal coverage and unified financing.