Immigration Enforcement in Healthcare Settings: How to Prepare and Respond
HealthBegins January 30, 2025

BACKGROUND INFORMATION

On January 20, 2025, Trump administration officials issued directives that rescinded previous protections against Immigration and Customs Enforcement (ICE) actions around “sensitive locations,” including hospitals, schools, and places of worship.

This rescission of protection for sensitive locations could impact healthcare organizations in multiple ways. One, it deeply affects the real and perceived safety of communities we serve at the places where they live, work, study, worship, and seek care. Two, it potentially opens healthcare institutions to new types of encounters with ICE officials on their property.

This action comes in the context of a broader set of actions by the new Trump administration to restrict new immigration and expel immigrants currently in the U.S., which may create a broader atmosphere of fear among patients and communities that healthcare organizations serve and make some hesitant to seek care or engage in other health-promoting behaviors, such as attending school or participating in religious services.

Many of our healthcare partners are asking how they should prepare for potential ICE encounters on their premises and respond in the interim to concerns among patients and staff. The following questions, answers, and resources provide some guidance.

Note: HealthBegins does not provide legal services or advice. The following information is curated from reliable outside sources. We will continue to update this information as policies change and new or better resources come to our attention. We welcome your suggestions of additional resources and other policy topics for us to cover.

(Last updated: January 29, 2025)

QUESTIONS, ANSWERS, AND RESOURCES

What immigration-related policy changes has the new administration implemented? How might they impact healthcare providers and social service organizations?

As of this writing, the Department of Homeland Security (DHS) has issued two directives opening sensitive locations to potential ICE actions. The first, mentioned above, rescinds protections at such places as hospitals, schools, and places of worship. The second rescinds protections at courthouses, while specifying that agents “should generally avoid enforcement actions” at courthouses “wholly dedicated to non-criminal proceedings (e.g., family court, small claims court).”

These orders now permit ICE officials to conduct enforcement at such locations, but they do not explicitly direct ICE to do so. The likelihood and frequency of such actions occurring remains unknown. Still, lawyers and advocates warn that healthcare providers should prepare for an uptick in enforcement on their premises. In addition, the chilling effect of the orders may affect healthcare patients and staff, whether or not ICE encounters occur in their area.

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How should healthcare staff respond to ICE information requests?

Healthcare staff have no obligation to comply with agents’ requests for information unless they have a warrant signed by a court (as opposed to an administrative warrant signed by another ICE officer). Compliance with such requests is voluntary. In some cases, HIPAA or other medical privacy rules may bar compliance. It can be helpful to designate an authorized staff person who is well-versed in the law and serves as the point person to respond to ICE information requests.

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What can providers and care team members do and not do if ICE wishes to conduct raids in their facility? 

The sensitive locations rescission changes DHS policy but does not change the rules governing how hospitals can and cannot respond. In general, hospitals must allow ICE agents in any areas where they would allow general members of the public. ICE agents may be excluded from private areas that are clearly posted and enforced for patients and family. Healthcare facilities should prepare for such an event by establishing clear policies and posted notices for private areas. Facilities can conduct drills to support staff confidence and train on how to respond to ICE agents.

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What educational resources can providers share with staff, patients, or clients?

It is important for providers to make sure their teams and patients have accurate, up-to-date information. Making educational resources available is one way to assure patients and team members that their health and safety are at the forefront of provider efforts. Establishing a relationship with local immigration advocates and lawyers is a good way to stay abreast of current information and resources.

Resources:

  • Red Cards/Tarjetas Rojas can be printed to help people assert their rights in many situations, such as when approached by ICE agents. Available from the Immigrant Legal Resource Center in 16 languages.

  • Know Your Rights Handout includes information for immigrants and citizens on how to make a childcare and family preparedness plan, which documents to carry, and what immigrants and allies can do if approached by ICE agents. Available from the Immigrant Legal Resource Center in eight languages.

  • Know Your Rights printable toolkit from Illinois’s Resurrection Project, including a rights card, emergency family planning checklist, and door sign.

  • Know Your Rights resource directory from the Immigrant Legal Resource Center.

  • American Civil Liberties Union scripts for how to respond in a variety of scenarios, in English and Spanish.

  • We Have Rights video tutorials on protecting rights during encounters with ICE agents and witnessing and documenting ICE arrests.

How can healthcare organizations protect patient data? How can Medicaid agencies protect enrollee data, especially in states that have rolled out new programs for undocumented individuals? 

Legal advocates recommend steps including:

  • Avoid asking patients for their immigration status unless directed to by law.

  • Avoid writing patients’ immigration status into their medical or billing record.

  • Inform admitted patients of their right to decline to be listed in the hospital registry.

  • Where healthcare staff are required to ask patients about their immigration status, as in Texas, inform patients that they are not required to respond.

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