Minnesota is extending state-funded health insurance eligibility to participants in an Obama administration deportation reprieve program — amid intense uncertainty about that program's future.

This month, the state became the fourth nationally to open subsidized health coverage to recipients of Deferred Action for Childhood Arrivals, or DACA, which offers temporary work permits and deportation stays to people brought to the United States illegally as children. On the campaign trail, President-elect Donald Trump said he would repeal the program, but he has since appeared to soften his stance.

Advocates say they've been lobbying the state Department of Human Services since well before the election to make about 6,000 DACA recipients eligible for MinnesotaCare if they meet income requirements.

"Immigration is complicated, and health care is complicated, so it's taken some time," said John Keller, executive director at the Immigrant Law Center, a St. Paul nonprofit that pushed for the change. "DACA has allowed young people to contribute at a higher level."

Meanwhile, DACA critics have argued that extending additional benefits to the program's recipients incentivizes illegal immigration. They say states and local governments are setting the stage for a showdown with the Trump administration, which takes over Friday.

'Minnesota law permits this'

Keller said what complicated the center's case for coverage is the fact that the federal government explicitly blocked DACA recipients from applying for health care subsidies under the Affordable Care Act. But Minnesota law has long allowed MinnesotaCare applications for immigrants on deferred action, a quasi-legal status that allows recipients to stay and work in the United States temporarily but doesn't open avenues to permanent residence.

"Minnesota law permits this coverage for those who enroll, and DHS will work with our county and community partners to assure access for these Minnesotans just as we would for any of the over 1 million people we serve each year," DHS Commissioner Emily Piper said in a statement.

About two dozen DACA recipients have applied since Jan. 1. DACA applicants must meet residence and income requirements for the program, sometimes described as the state's option for the "working poor."

DHS said it does not have estimates for the number of DACA recipients likely to benefit from MinnesotaCare or the resulting cost to the state. The program is funded by a state tax on Minnesota hospitals and health care providers, enrollee premiums, the federal government and other sources.

Minnesota moved quickly to offer driver's licenses to program beneficiaries after Obama launched it in 2012; it also offers in-state tuition and financial aid regardless of immigration status. Now it has joined California, New York and Massachusetts as well as the District of Columbia in offering state-funded health coverage, according to data from the National Immigrant Law Center.

The change was hailed by advocates, including the group Navigate, which supports DACA recipients. It applauded the state's "commitment to close health equity gaps."

"It's only a matter of fairness," said Pablo Tapia, co-founder of the advocacy group Asamblea de Derechos Civiles, or Assembly for Civil Rights. "DACA recipients pay taxes and contribute a lot to our society."

Last summer, Karen Velez, a DACA recipient in the Twin Cities, tried to ignore a bout of abdominal pain and high fever. She was busy juggling a full-time job as a store manager and full-time studies at Inver Hills Community College. Her employer doesn't offer health coverage, and she worried about the cost.

But as the pain worsened, she went to an urgent care clinic and found out she had a kidney infection. She is still paying off a bill of roughly $2,600 for her day at the hospital and an MRI.

Although she was disappointed to learn her income is too high to qualify for MinnesotaCare, she is still thrilled.

"This is a relief for many young people who can benefit," she said.

The future of DACA

Ira Mehlman, a spokesman for the Federation for American Immigration Reform, which advocates for limiting immigration, said state-level efforts to provide publicly subsidized coverage flout the will of the U.S. Congress, which chose to make Affordable Care Act subsidies off-limits to DACA recipients. He said he believes the timing of Minnesota's decision is significant.

"These are politically motivated policies by local jurisdictions preparing to do battle with the new administration," he said. "States should not be in the business of making it easier for illegal immigrants to stay in the United States."

Rep. Matt Dean, R-Willernie, chairman of the state House Health and Human Services Finance Committee, declined to comment on the change until he receives more information from DHS and nonpartisan analysts.

For DACA recipients and their supporters, the MinnesotaCare decision comes at a moment of high anxiety. Repealing DACA and stepping up deportations were among Trump's campaign trail pledges. But in a more recent Time magazine Person of the Year interview, Trump noted DACA recipients were brought to the U.S. at a young age, and some have "wonderful jobs."

"We're going to work something out that's going to make people happy and proud," he said.

A bipartisan group of U.S. senators is pursuing legislation that would allow DACA recipients to keep their work permits for three years if the Trump administration ends the program. Last month, Minneapolis Mayor Betsy Hodges joined the mayors of 15 other cities in signing a letter that asked Trump to spare the program; the letter argued it fosters economic growth and improves public safety.

But DACA also has foes on Capitol Hill who see it as a symbol of the Obama administration's executive overreach.

Some parents of DACA recipients told Keller at the Immigrant Law Center that they are nervous their children would put themselves on the government's radar if they apply for MinnesotaCare. He believes some might hold off on applying.

Velez has mixed feelings about the program's prospects.

"I am hopeful, and I am anxious," she said. "We work. We pay taxes. I hope the president will realize that taking DACA out is not beneficial to him."