After President Barack Obama raised publicity in June with his declaration that 800,000 young undocumented immigrants could remain and work in the United States, his administration quietly issued a rule this week declaring that these immigrants can’t benefit from the healthcare reform law.

The Department of Health and Human Services released a rule amendment to clarify that the Affordable Care Act, which offers coverage to those “lawfully present” in the United States, did not apply to those mentioned in Obama’s June declaration.

The amendment means that the undocumented immigrants will not be able to join the Pre-Existing Condition Plan for high-risk patients and the healthcare exchanges being established to help people and small businesses obtain cheaper rates. The immigrants will also not be able to get into state-federal programs such as Medicaid, the health insurance for the poor, or the Children’s Health Insurance Program.

“This certainly is a substantial financial issue in places like Miami, New York City and Los Angeles,” said Alan Sager, a healthcare policy expert at Boston University. He called the ruling “a relatively minor administrative clarification, a screwing down of something that was already nailed down.”

The reason is that, in an attempt to get support from conservatives for the reform bill in 2010, Democratic lawmakers promised that undocumented immigrants would not benefit from the act.

Obama’s June announcement affected immigrants under 31 who were brought into the United States illegally as children. His move did not formally grant them residency or permanent legal status, but allowed them to stay and work in the country.

That action, HHS decided, did not mean these immigrants were “lawfully present.” On Monday, it issued a 12-page amendment to the reform act regulations “so that the program does not inadvertently expand the scope” of the act.

The issue of immigrant healthcare is huge for South Florida. As many as a third of the uninsured patients at Jackson Health System are believed to be undocumented.

State-federal funds pay for their emergency care until they are considered stable, but any other treatment falls on county taxpayers if they go to a government hospital. If they go to other hospitals, the facilities get reimbursed for their care by charging higher rates to insurers and paying patients, Sager said.