Author: Joseph Quintana

Denying Medical Care to ICE Detainees: Treating Their Needs as Optional 

In just one year, the number of people detained by Immigration and Customs Enforcement (ICE) has increased by over 75%, with a record 73,000 people held in detention as of mid-January. As anti-ICE protests across the country call attention to detainees, there is an increasing need to understand the questionable, frequently opaque conditions within ICE detention centers. 

There is mounting evidence that demonstrates ICE detention centers lack the infrastructure to provide basic care to those in the custody of ICE. Consequently, detainees are subjected to persistent medical neglect. These conditions, at least in part, persist due to a lack of legal accountability and legal protections. Immigration detention operates in a state of lawlessness, not because no law applies, but because courts have refused to enforce the law that already exists. The result is a system where ICE detainees routinely fail to receive necessary medical care, while the constitutional limits on that failure remain unenforced.

For those in ICE custody, many remain detained for months or years while their immigration cases proceed. During that time, detainees depend entirely on the government, or its private contractors, for their medical care. Yet, reports and court records consistently document delayed diagnoses, untreated chronic illnesses, failures to provide medication, inadequate mental health care, and preventable deaths. These failures are not isolated incidents. They are repeated offenses, and the law’s ability to serve as a tool to fight against these conditions has been strikingly meager. 

The Supreme Court has long made clear that when the government takes a person into custody and deprives them of their ability to care for themselves, it assumes an affirmative constitutional obligation to meet basic human needs, including medical care. In the prison context, the Court held in Estelle v. Gamble that “deliberate indifference” to a prisoner’s serious medical needs constitutes cruel and unusual punishment under the Eighth Amendment. That case established the floor: Once the state confines a person, medical neglect can qualify as a constitutional violation. 

But immigration detainees are not prisoners. Immigration detention is formally civil, not punitive; it is governed by the Fifth Amendment’s Due Process Clause. Under settled doctrine, civil detainees may not be subjected to conditions that amount to punishment. The Court articulated this principle in Bell v. Wolfish, holding that conditions of civil confinement must be reasonably related to legitimate governmental objectives and not excessive in relation to those objectives. If a condition lacks such a justification, courts may infer that it is punitive and, therefore, unconstitutional. The Court reinforced this affirmative duty framework in Youngberg v. Romeo, holding that when the state confines individuals and renders them dependent on institutional care, due process requires reasonable measures to ensure their safety and basic well-being. 

In theory, this constitutional framework could provide greater protection to ICE detainees than to convicted prisoners; however, courts have done the opposite, instead reinforcing executive deference related to ICE detention conditions. COVID-19 litigation exposed this flaw starkly. In cases like Hope v. Warden York County Prison and Fraihat v. U.S. Immigration & Customs Enforcement, federal appellate courts overturned lower-court orders that sought to protect medically vulnerable detainees. The courts emphasized ICE’s institutional competence and its stated detention interests, while declining to meaningfully scrutinize whether conditions had become unconstitutionally punitive. The consequence is that constitutional rights may exist, but they have been functionally unused. 

From a health policy perspective, judicial inaction could delay essential care. When legal obligations are unclear or unenforced, medical care becomes discretionary. ICE detention is not an exception to constitutional governance; it is a test of it. As long as courts treat immigration detention as a zone of exceptional deference, detainees’ health will remain subject to policy choice rather than legal duty. Until courts reckon with this discrepancy, detainees will continue to suffer the consequences. 

Detaining Medical Information: The Growing Threat to Immigrants’ Health Care Access

Emboldened by President Trump, armed and masked immigration enforcement agents are increasingly threatening the public and conducting raids to detain people whom they suspect are undocumented immigrants. Attention, both in popular and social media, has primarily focused on immigration enforcement in areas once considered safe, including raids occurring in schools, public parks, and grocery stores. However, these highly publicized incidents overshadow an alarming immigration enforcement and detention strategy—confiscating immigrants’ medical information. 

This past June, the Trump Administration granted Immigration and Customs Enforcement (ICE) officials access to the personal information of millions of Medicaid enrollees. This information included home addresses, ethnicities, social security numbers, and even immigration status. Initially, U.S. Department of Health and Human Services (HHS) officials stated that the goal of the transfer was to disqualify those improperly enrolled in Medicaid. The Associated Press, however, obtained a copy of the agreement between the Centers for Medicare & Medicaid Services and the Department of Homeland Security, which indicates that the purpose of the data is to allow ICE to “find the location of aliens.” It seems that it is no coincidence that the states targeted in the data transfer—California, New York, Washington, Oregon, Illinois, Minnesota, and Colorado—all have programs that allow non-citizens to enroll in Medicaid. 

In response, 20 states sued the federal government, arguing that the data release violated federal health privacy laws, including the Health Insurance Portability and Accountability Act (HIPAA). In August, a federal judge issued a partial preliminary injunction precluding ICE from using the accessed data. Citing key cases such as FCC v. Prometheus Radio Project and FCC v. Fox Television Stations, Inc., Judge Vince Chhabria found that the government’s decision was arbitrary and capricious. As the case continues to play out in the courts, it is imperative to discuss its implications for privacy concerns and, more importantly, the intense chilling effect it will create, both in the present day and potentially for decades to come.

Now that such medical information, which includes citizenship status, is in the possession of ICE, there is certainly a fear that this information will be used to track down and detain immigrants (or those who may appear as undocumented immigrants to authorities). But beyond the looming threat of ICE using the data to detain people, there is also a harmful chilling effect: immigrants are reporting that they are avoiding health care facilities entirely. 

The relationship between immigrants and the United States health care system was already precarious. Examples of systematic, repeated racism in the health care system have already strained migrants’ trust. Furthermore, there are several documented cases in which doctors have engaged in medical care without informed consent or conducted unethical research on immigrants. These stories and incidents have created enduring narratives that understandably engender distrust in the American health system. As a result of these deeply embedded fears, immigrant communities are more likely to attempt to avoid the health care system altogether until their health situation becomes dire. 

ICE’s entanglement in our health care system is a moral and economic injury. Managing an effective health care system needs more than just surgical kits, prescriptions, and check-ins. It requires fostering a safe environment where people, regardless of their citizenship status, can receive the care they need. Furthermore, it is commonly cited that immigrants invest more in American health care than they deduct. Several health policy scholars have demonstrated that ensuring communities have access to preventative health care is cost-saving for the country’s overall economy.

Freely handing sensitive Medicaid data to ICE is a betrayal of the core values of health care: autonomy, trust, and privacy. The fear of detention since Trump’s first presidency already loomed over immigrant communities. However, this distrust and fear are now magnitudes worse due to the cruel and novel tactics now being employed by ICE. Embedding immigration enforcement within health care is harmful; some may even argue that the goals of the two institutions are inherently at odds. As ICE raids increase in intensity across the country and immigrants become increasingly aware that their data is now in possession of ICE, this fear––and resulting harm––will grow.