The Choice Before Us: Protecting Hospitals as Places of Healing 

By Erin Miller, Deputy Director of Policy at Community Catalyst and Karla Martinez.

Trust is the foundation of public health and hospitals are places where that trust is crucial. They are the places where people interact with the healthcare system at incredibly vulnerable times — during medical emergencies, childbirth, serious illness, and more. Unfortunately, anti‑immigrant policies across a range of states in the country are eroding that trust. 

Policies that require hospitals to ask patients about their immigration status are harmful to patients, public health, and state health systems. They create fear that discourages people from seeking care, drive inequities, worsen health outcomes, and fail to address the real drivers of rising healthcare costs, such as workforce shortages, consolidation and lack of coverage. Instead, these measures deepen existing health disparities and shift costs downstream in the health system — hurting families, providers and communities alike. 

The Landscape: When States Make Hospitals Places of Immigration Enforcement 

Why it matters: Fear in healthcare settings doesn’t stay contained. It leads to delayed care, worse outcomes, higher costs for everyone in the health system, and weakened trust in institutions meant to heal. 

In recent years, several states have advanced policies requiring hospitals to collect information about patients’ immigration status, often framed as cost tracking or accountability measures. 

Where harmful policies are in effect: 

• Florida requires hospitals that accept Medicaid to ask admitted patients and emergency room visitors about their immigration status. 
• Texas requires hospitals to collect and report patient immigration status data to the state. 

Where similar policies have been proposed — and stopped: 

• In Arizona, legislation requiring hospital data collection passed the Legislature but was vetoed by the governor. 
• A similar bill was introduced in Idaho but ultimately failed. 

What These Policies Do — and Do Not  Do 

Despite the fear these policies generate, core legal protections still apply: 

• Emergency care is guaranteed. Under EMTALA, hospitals must provide emergency care to anyone who needs it, regardless of immigration status.
• Answering immigration questions is voluntary. Patients cannot be compelled to respond.

Even so, simply asking immigration status questions is often enough to chill care-seeking — particularly in emergency departments and inpatient settings, where people are least able to navigate fear, confusion or misinformation. 

These harms are compounded by broader federal actions, including the erosion of sensitive-location protections in healthcare settings and deepening concerns about data-sharing between health programs and immigration enforcement. Together, these actions create a dangerous ecosystem that undermines trust in healthcare institutions. 

What the Evidence Shows 

Across states and over time, the evidence is clear: 

1. Undocumented immigrants access healthcare services less than the rest of the population. Decades of research show they use health services far less frequently than U.S.‑born citizens and other immigrant groups. 
2. These policies increase fear and delay care. Florida and Texas data show that immigration status collection has not uncovered meaningful cost savings or overuse. 
3. They raise costs. When people delay preventive care or avoid care altogether, conditions worsen and emergencies become more frequent and costly. 

In Florida, state reporting shows that undocumented immigrants represent a very small share of hospital visits. In Texas, dozens of hospitals reported no undocumented patients at all. These requirements have produced administrative burden for hospitals, confusion for frontline workers, and widespread fear in communities.

The downstream impacts are significant. Families delay care — sometimes even for children. Providers experience moral distress when trust breaks down in exam rooms. Health systems divert time and resources away from patient care. Entire communities become sicker when access to care is disrupted.

States Choosing a Better Path 

Even as federal protections have weakened, some states have moved in the opposite direction — strengthening safeguards so hospitals remain places of care, not enforcement. 

• California started prohibiting medical facilities from allowing federal agents into private areas without a valid warrant or court order following documented incidents of immigration enforcement targeting hospitals and patients. 
• Colorado strengthened data protections and requires public entities, including hospitals, to have clear policies governing interactions with immigration enforcement. 
• This Spring, Connecticut established protections for hospitals from immigration enforcement because of advocacy from community, labor, and faith organizations. 
• After large-scale immigration enforcement actions traumatized communities, Illinois moved to protect patient data and require hospitals to develop protocols for encounters with law enforcement. 

These policies show that states can choose to protect healthcare access — and public trust. 

Defending Care Without Fear: Preventing and Mitigating Harm 

Strengthening protections and preventing harmful policies from passing is the best outcome. But in states where harmful mandates advance, advocates have shown that mitigation efforts can meaningfully reduce harm. 

Effective mitigation strategies include: 

• Explicitly stating in statute or guidance that patients are not required to answer immigration status questions. 
• Requiring any immigration related questions to occur after triage. 
• Ensuring questions appear only on optional written forms, not during verbal intake. 
• Clearly communicating patient rights and language access in the languages communities use. 

In Florida and Texas, health and immigrant rights advocates moved quickly to protect communities. They launched Know Your Rights campaigns encouraging broad refusal to answer immigration questions — reducing both fear and the usefulness of the data. They educated providers and patients through coordinated media outreach and community partnerships. 

Hospitals also play a critical role. Health systems can adopt internal policies that prioritize patient safety, limit unnecessary data collection, and provide clear, multilingual information at the point of care — even when state mandates apply. 

What’s Next: Protecting Hospitals as Sensitive Locations 

The lessons from these states point to a deeper need for structural change and rebuilding trust. We cannot allow hospitals to become instruments of fear rather than places of healing. 

Clear federal protections are essential. Community Catalyst supports the Protecting Sensitive Locations Act, which would limit immigration enforcement actions in healthcare facilities nationwide. Health data must also be protected from misuse, with immigration status clearly treated as sensitive health information. 

However, policy change alone is not enough. These policies and actions thrive on fear and misinformation. Countering them requires narrative change strategies that center care, dignity, and shared wellbeing. Community Catalyst’s Immigrant Health Messaging Guide offers a tested framework to help advocates lead with values, acknowledge complexity, calm fears, and activate hope — grounding arguments in what people already believe about family, fairness and care.