Provider Resources
Resources to support healthcare providers, including sample letters, guidance on benefits, and more
Restrictive immigration policies negatively impact health outcomes and deter individuals from seeking care. The rollback of protections for health care settings as “sensitive locations” and new state-level requirements to report immigration status further contribute to fear and reduced health care access. Given these challenges, health care institutions have an ethical responsibility to prioritize patient well-being, uphold medical ethics, and advocate for policies that protect immigrant communities. This article reviews the ethical implications and responsibilities for healthcare providers.
Institution-wide trainings on immigrant and refugee policies, messaging, and advocacy are crucial for standardized, consistent policy dissemination. These trainings ensure coordinated responses to emergencies, similar to fire safety or active shooter protocols. Regular staff trainings help institutions adapt to evolving federal policies while upholding core values. Publicly prioritizing such trainings reinforces the institution’s commitment to inclusion and equity for all affected by xenophobia, discrimination, and hate.
Immigration policy is changing quickly in 2025. Keep track of the latest immigration policy updates with the Immigration Policy Tracking Project (IPTP). IPTP compiles and indexes all identifiable Trump 1.0 and 2.0 immigration policies with keysource documents and the current status of each policy.
Providers can who want to learn more about supporting people seeking asylum can volunteer to do clinical evaluations for asylum seekers - check out the Asylum Medicine Training Initiative and Society of Asylum Medicine for more information.
Supporting individuals and organizations involved in this work is essential for fostering resilience and preventing burnout. The Witness to Witness Program from the Migrant Clinicians Network offers a supportive community, valuable resources, and tools to sustain those serving vulnerable populations.
Patient & Provider Rights
What We Know
It is critical for frontline providers to understand both their rights and their patients' rights. By knowing the limits of law enforcement's power, we can better protect our patients, their communities, and ourselves.
Below is a brief summary of the legal protections available to us, the vulnerabilities we may face, and resources to deepen our understanding of patient and provider rights.
Protections
1) The 4th Amendment still protects people against unreasonable search and seizure. This limits the power of law and immigration enforcement.
2) HIPAA limits what health care providers are able to share related to protected health information
3) Warrants or consent are required for entering a private area, including areas within a health care facility designated as 'private.'
4) The 5th Amendment provides everyone the right to remain silent, regardless of status
Vulnerabilities
1) The 4th Amendment does NOT protect against "reasonable" searches. 'Reasonable' is determined by the subjective and objective expectation of privacy.
2) Clinic areas that are seen as public are subject to law enforcement presence without a warrant or consent. In these areas, they can question anyone, but everyone can remain silent.
3) Law enforcement CAN search private areas if they have "probable cause" to suspect past, present, or future unlawful activity.
4) Anything that is in "plain view" or "plain hearing" in a public area is fair game.
5) Consent exception presents a risk because agents will believe/say that they have consent unless staff is clear that they do not consent
6) Agents can engage in enforcement at protected areas with prior approval from leadership or under exigent circumstances. Note that a new administration could substantially weaken or abandon the protected areas policy
Healthcare, Immigrants and Legal Protections
National Immigration Law Center (NILC)
Webinar: Protecting Your Immigrant Patients' Access To Health Care (April 24, 2017)
Powerpoint slides from an excellent NILC webinar overview of some basics, the current landscape, legal rights, and how to create safe spaces.
National Immigration Law Center (NILC)
Know Your Rights, Know Your Patients' Rights (2024)
Information for health care providers on how to prepare for and respond to enforcement actions by immigration officials and interactions with law enforcement. Originally published in April 2017, updated in 2024.
Coordinating with Attorneys to Advance Care for Immigrant Patients
Tip sheet offering practical knowledge to those coordinating with attorneys and writing letters of support for their immigrant patients.
Professional Association/
Organization Toolkits
Professional organizations are creating specialty specific or regional toolkits to help providers deliver safe and inclusive care to patients in a variety of settings. You can explore some of these below; please use the "contact us" form to share other toolkits you find helpful.
Alameda Contra Costa Medical Association
Health & Law Immigrant Solidarity Network
Best practices for healthcare centers to support immigrant patients
Guidelines to build your own inclusive spaces that will better serve the public health and healthcare needs of people in RIM communities. These tips consider everything from the entry point into the physical space to the interactions patients have once inside.
Using Public Benefits
What services can immigrants safely access?
More than ever, immigrants are forgoing benefits for fear of discovery or retaliation.
The evolving policies around Public Charge rules continue to create confusion and fear, particularly for low-income immigrants seeking to enter the U.S. or obtain a green card.
While changes to these rules have been proposed in the past, it is critical for providers to stay informed about what is and is not true. The policy landscape remains fluid, so regularly consult trusted sources like Protecting Immigrant Families and All In For Health for updates and guidance.
Families and providers can check out the "Keep Your Benefits" website for state specific guidance related to public charge. There are no questions about name or address or other personal details. The site allows you to explore public charge implications of different scenarios and is available in English, Spanish and Mandarin Chinese.
What We Know
1) The Biden administration’s public charge regulations are still in effect. See the PIF site for details.
2) Immigrants should never misrepresent information on applications.
3) It is still not clear what will happen with DACA. It is recommended that anyone considering submitting a DACA application should first talk to an immigration attorney or a Board of Immigration Appeals-accredited representative.
Health Insurance
1) As of now, ACA stands true, and anyone eligible should apply.
2) A growing number of states, including California, are using their own resources to provide Medicaid to their residents regardless of immigration status. More information on CA coverage for adults regardless of documentation status is available here. All in for Health also has a helpful one pager for Californians in multiple languages here.
3) Immigrants should apply for health coverage through the ACA marketplace. If they are undocumented and applying for someone in their household, they should not provide any information about their immigration status and instead say “I am not applying for health insurance for myself.”
Public Benefits
National Immigration Law Center (NILC)
California Major Benefits Programs Available to Immigrants (Nov 2024)
CA Department of Health & Human Services
Public Charge Guide (available in 21 languages)
The CalHHS Public Charge Guide provides current information regarding federal changes to “public charge” determinations and the use of public benefits.
San Francisco Human Services Agency
Post-Election San Francisco Public Benefits FAQ (May 2024)
Chinese I English I Spanish | Tagalog | Russian | Vietnamese
Mass Legal Services
Immigrants & Public Benefits: Basic Benefits Training Resources (March 2024)
Mostly Massachusetts focused, but some broader information as well
Health Care Access for Immigrant Youth and Families in California (for non-medical providers)
Tip sheet offering practical knowledge to attorneys serving immigrant youth and families who are in need of connecting to medical and behavioral health care.
National Immigration Law Center (NILC)
Webpage with articles reviewing the concept of "Public Charge," and how that relates to immigration. While some of the materials are older, the definitions still apply.
Benefits Finder in English & Spanish
Online benefits finder. Undocumented immigrants are not eligible for most federal benefits, but many states provide some benefits that do not require documentation status. This site can be searched by state, benefit type, or families can enter their information for a personalized list. It is ideal if families in need of assistance can beet with a social worker or other specialized provider to help them navigate the system. Since this is a government site, patients should be cautious about entering too much personal information.
Documenting Safely
What should NOT be put in the chart?
Simply put, HIPAA laws are still in place, which means any health information that might identify a specific individual is protected by the law. That said, experts advise that, as much as possible without hindering clinical care, providers AVOID COLLECTING OR RECORDING immigration-related information.
TX and FL now have policies that require hospitals to ask patients about their immigration status. Even in those states people can decline to answer and providers cannot make access to care depend on their response.
HIPAA & the Medical Record
HIPAA does not protect PHI against all disclosures.
HIPAA permits, but does not require, disclosure to comply with legal processes such as court orders, subpoenas, or warrants. The exception allows only the minimum necessary information to be disclosed to fulfill the legal requirement. It further places specific limitations on information disclosures in administrative proceedings.
Providers should refer law enforcement disclosure requests to counsel and advocate for a policy of nondisclosure where possible. See the HHS resource and other resources below for more details.
PHI, Law Enforcement, & The Fourth Amendment
US Department of Health & Human Services
When does the Privacy Rule allow covered entities to disclose PHI to law enforcement officials?
Reviews conditions when a provider is required to release PHI
National Immigration Law Center (NILC)
Know Your Rights, Know Your Patients' Rights
Guide to providing information to law enforcement
Medical Forms & Letters
Supporting patients/caregivers facing deportation.
Physicians may be asked to write letters for their patients. Below is guidance on letters writing for healthcare providers.
We also share examples of letters that can be used to document the importance of parents in meeting medical needs of their children.
This tipsheet offers practical knowledge to those coordinating with attorneys and writing letters
of support for their immigrant patients.
Michigan Immigrant Rights Center
Writing a Letter of Support for Immigration Purposes
Provides guidance for a general letter of support
American Academy of Pediatrics
The Toolkit for Immigrant Child Health has a number of helpful resources. Page 24 has guidance for letter writing
General guidance on writing a letter for a child with special medical needs
Two-pager from KY AAP Immigrant Child Health Task Force on what to include, how to write a letter
Sample Letter for Parents of Child with Medical Needs
Letter of support for parents at risk of deportation, documenting risk to medically fragile child.
Sample Letter for Parents of Child with Special Needs
Letter of support for parents at risk of deportation, documenting risk to child with special needs.
Sample Letter for Visiting Sick Relative
Advocating for a Family Member in another country to visit their medically sick relative
Sample Letter to Prevent Deportation
Letter of support for preventing deportation of a patient
Sample Letter to Demonstrate Residency (>2 year)
Letter documenting patient/parent has resided in the US for over 2 years; developed to support families at risk of expedited removal
(N-648) Form: Disability Exception for Citizenship:
Form N-648 can be filled out by medical providers on behalf of immigrant patients who are applying for citizenship yet are unable to complete the English and/or civics portions of the U.S. citizenship test.
Disability Exception for Citizenship (N-648) Form Instructions
This information is designed to provide information for medical providers completing the N-648 form.
Special Considerations: Dementia Care Aware
This handout from Demential Care Aware offers guidance to providers supporting asylum seekers with cognitive decline, including guidance on completing form N-648, public benefits, and naturalization.
Supporting Patients Seeking Citizenship: Dementia Care Aware
This video from Demential Care Aware offers guidance to providers supporting patients seeking citizenship
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