This article was republished with permission from WTOP’s news partners at Maryland Matters. Sign up for Maryland Matters’ free email subscription today.
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A plan to give undocumented immigrants access to Maryland’s state health insurance marketplace next year has been put off until 2028 by state officials. The delay comes amid recent federal policies affecting immigrants and overall uncertainty in health care markets.
The postponement was one of the biggest changes outlined for state lawmakers Thursday by health care and health insurance officials during a joint virtual meeting of the Senate Finance and the House Health and Government Operations committees. They discussed the impact of recent Trump administration policies on Maryland’s health care system.
The meeting covered policies expected to increase health insurance costs, create barriers to accessing plans, and reduce federal funding to Maryland, among other effects. It also explored ways Maryland might respond to these challenges.
Michele Eberle, executive director of the Maryland Health Benefit Exchange, expressed disappointment over the delay in implementing the Access to Care Act. This legislation would have allowed undocumented immigrants to use the Maryland Health Benefit Exchange to compare health plans and select the most suitable insurance for their households.
Currently, undocumented immigrants can purchase health care plans directly from insurers but are barred from using the state exchange to shop around. The 2024 Access to Care Act aimed to change that by opening the marketplace to undocumented residents, pending federal approval.
Although the law would not have provided undocumented residents access to federal subsidies that make health care affordable for many, it would have given those able to pay without subsidies a chance to use the online marketplace to weigh their options.
The state had secured a waiver from the federal government while President Joe Biden was still in office, allowing the law to take effect next year.
However, due to the Trump administration’s harder stance toward undocumented immigrants and significant changes to health care funding, the exchange decided to delay opening the marketplace to undocumented residents until 2028.
“We worked really hard under the last [Biden] administration to make sure that it was approved and we were all set to go,” Eberle said. “We did not anticipate at that time that we would have the Marketplace Integrity Rule or HR 1 that would throw up a whole bunch of new requirements that we would have to put in place in short order.”
The Marketplace Integrity Rule and HR 1 (also known as the One Big Beautiful Bill) overhaul parts of the Affordable Care Act and other federal health regulations. States like Maryland must now focus their resources on complying with these changes.
One significant impact of the Marketplace Integrity Rule was the revocation of a Biden-era decision classifying immigrants covered by the Deferred Action for Childhood Arrivals (DACA) program as “lawfully present” individuals. This classification would have granted DACA recipients access to federal subsidies that help make health care affordable.
Without this classification, DACA recipients lose access to those subsidies. This change is expected to affect about 300 DACA recipients in Maryland who currently benefit from these subsidies.
Federal decisions targeting Maryland’s undocumented and immigrant populations were just part of what Maryland Insurance Commissioner Marie Grant described as “gloomy but important” health care-related updates under the Trump administration.
Grant highlighted the significant rise expected next year in insurance premiums, due in part to the anticipated expiration of pandemic-era federal tax credits that helped reduce the cost of individual plans purchased through the Affordable Care Act.
In September, the Maryland Insurance Administration approved an average premium increase of 13.4% across plans for next year. While this increase was less than what insurance companies initially requested, it still represents a significant rise in monthly costs for many low- to middle-income families.
Health care advocates fear that many people will drop coverage due to affordability issues if those tax credits expire. Insurers counter that rate increases are necessary to offset the expected number of individuals who may forgo insurance because of high costs.
To mitigate this, the General Assembly approved funding this year that will partially replace the soon-to-expire federal tax credits for the coming year. However, analysts caution that these state subsidies are only temporary fixes and that many people will still face higher monthly costs than they did this year.
Congress could vote to extend these tax credits, a key issue in the current government shutdown debate. However, Grant warns that time is running out to make that decision with an impact on 2026 health care plans.
“We’re expecting those enhanced tax credits to expire by the end of this year, unless Congress takes action to extend them,” she said. “The clock is ticking. It is likely we’re getting to a point where, unless this extension happens in the next couple of days, it is likely too late to have carriers refile rates for 2026.”
https://wtop.com/maryland/2025/10/undocumented-residents-access-to-maryland-health-insurance-marketplace-delayed-from-2026-to-2028/