Fact check: How do undocumented immigrants currently access healthcare services in the US?

1. Why safety‑net clinics are the default health door for undocumented people

Multiple studies show community health centers (CHCs) and outpatient clinics serve as the principal entry point for routine care among undocumented immigrants, handling thousands of visits without requiring insurance or documentation. A July 2025 study of undocumented patients linked to a large urban CHC documented that most routine care occurs at these centers, and that expanding CHC hours, services, and care coordination could reduce inappropriate ED reliance ^[1]. A 2024 pilot survey among circular Mexican migrants likewise found most care occurred in outpatient/community clinics (≈62%), with private offices accounting for roughly 30% of visits, illustrating the central role of safety‑net outpatient infrastructure ^[2]. Earlier work from New York City in 2007 corroborated these patterns, with clinics and CHCs reported as the main regular providers ^[3].

2. Emergency departments remain an obligatory backstop, often for preventable needs

Federal law (EMTALA) requires EDs to treat anyone presenting with an emergency, and studies repeatedly show EDs are used as a safety valve when outpatient access fails. The 2025 CHC study reported 13% of encounters with undocumented patients resulted in ED visits, and notably 61% of those ED encounters were assessed as preventable or primary‑care‑treatable, signaling gaps in timely outpatient access ^[1]. The 2007 urban study and the 2024 border survey also recorded ED use at about 13%, often correlated with worse health status or barriers to outpatient care, suggesting ED reliance stems more from access constraints than preference ^{[2] [3]}.

3. Insurance gaps and policy fences shape who gets care and how often

Across the literature, uninsurance is a defining driver: recent analyses show undocumented immigrants have substantially higher uninsured rates than citizens, and policy choices at the state level affect coverage for lawfully present immigrants—while unauthorized immigrants remain largely excluded from public programs ^{[4] [6]}. The 2024 pilot study found only 29% had any U.S. health insurance, and the 2007 study noted only about 10% had insurance in the prior six months; having insurance and higher income correlated with greater access to usual care ^{[2] [3]}. Reviews highlight legal and documentation requirements as systemic barriers that funnel undocumented populations toward safety‑net providers ^[5].

4. Non‑policy barriers: fear, language, transport, and discrimination that deter care

Beyond formal eligibility rules, individual‑level obstacles—fear of deportation, limited English proficiency, transportation problems, and experiences of discrimination—consistently reduce care‑seeking and continuity. The pilot border survey identified unauthorized status, transportation barriers, and lack of insurance as the strongest predictors of forgone care, while the NYC study linked fear and language barriers to lower utilization ^{[2] [3]}. The literature review emphasized discrimination and resource constraints in health systems as persistent deterrents, indicating that even clinics willing to serve undocumented patients may face limitations in capacity and culturally competent services ^[5].

5. Outcomes and preventable utilization point to gaps in primary care capacity

Researchers flag preventable ED visits and unmet preventive needs as indicators that primary‑care capacity is insufficient for undocumented populations. The CHC study’s finding that 61% of ED encounters among undocumented patients were primary‑care‑treatable suggests missed opportunities for chronic‑disease management and prevention in outpatient settings ^[1]. The pattern of modest ED use but substantial unmet needs across studies implies that while EDs absorb acute episodes, they do not substitute for continuous care, which contributes to poorer long‑term outcomes and potential higher downstream costs ^{[2] [6]}.

6. Policy levers and service improvements shown or proposed to alter access

Studies propose policy and service‑level changes to improve access: expanding state options for immigrant coverage, extending CHC hours and services, bolstering care coordination, addressing transportation and language needs, and reducing documentation requirements in practice. The 2025 review noted some states expanded coverage for lawfully present immigrants but emphasized limited evidence on impacts for undocumented people ^[4]. The CHC study specifically recommended service expansions to reduce preventable ED use ^[1], while earlier works argued for policy reforms to remove eligibility barriers and enhance culturally and linguistically appropriate services ^{[5] [6]}.

7. What the evidence agrees on — and where it still gaps

Across time and methods, agreement is strong that safety‑net clinics are central, EDs serve as a required fallback, and legal, logistical, and cultural barriers drive disparities in access. However, evidence gaps remain about the effects of recent state policy experiments on undocumented populations, the effectiveness of targeted CHC expansions at scale, and precise causal links between access interventions and long‑term health outcomes. The most recent analyses through 2025 note the need for further research to quantify how policy and service changes translate into improved utilization patterns and health status for undocumented immigrants ^{[4] [1]}.