Even before the judge’s decision, a recent national survey found that 84 percent of health care providers reported decreases in patient visits and more than one-quarter said immigration enforcement was directly affecting patient care.
Two Boston-area mothers who requested anonymity due to their undocumented status said they learned to fear hospitals after people they knew were detained seeking medical help. Both of their children have missed multiple medical appointments as a result.
“I tried to make an appointment for my 8-year-old daughter because I noticed a skin condition, but when I tried, they sent us to the emergency room,” said one of the women, who initially took her daughter to a community clinic. “They made many follow-up appointments, but we didn’t go.”
The effect on children is most worrisome, providers say, as they typically need to be seen more often and are dependent on caregivers who may now be reluctant to leave home. Barrett, for example, said immigrant children are missing many more appointments at the New Bedford clinic. And, the new national survey found cases of immigrant parents sending their children alone to emergency rooms, waiting outside, or avoiding hospitals entirely.
Conducted by Physicians for Human Rights and the Migrant Clinicians Network, the survey gathered responses from 691 health care workers who serve immigrant communities in 30 states. Preventive services, chronic disease management, and mental health care were among the most affected. Nearly half of respondents cited fear of deportation for why families were not seeking medical care, while 39 percent pointed to fear of family separation, according to the survey, conducted from March through August and released in November.
Moreover, 7 percent of respondents reported ICE or Customs and Border Protection inside health care facilities. While there have been no recorded arrests at medical facilities, ICE vehicles have been spotted outside local hospitals.
Many families no longer feel hospitals are safe, a troubling development when they instead go to a community clinic for a severe illness.
“There have been several occasions when we’ve had to call 911 because someone is having an emergency like chest pain,” said Dinanyili Paulino, vice president of La Colaborativa, which runs a health clinic in Chelsea.
Even when staff urge patients to go to the hospital, many refuse, Paulino added. The Chelsea clinic is designed to provide preventive and acute care, Paulino said, but staff are increasingly seeing patients with serious, sometimes advanced conditions.
In response, volunteers at La Colaborativa and other local immigration advocates say they are escorting patients to hospitals, driving them to and from appointments, and picking up their prescriptions to help people get the care they need.
The New Bedford clinic has expanded outreach efforts and distributes “Know Your Rights” red cards. Signs posted at every entrance to the clinic clarify that ICE agents are not permitted in exam rooms, for example.
“ICE can’t go into private places, and we have it posted that this space is for scheduled patients only,” Bartlett said.
State Medicaid programs are required to share a trove of information about enrollees and the care they receive with the federal Department of Health and Human Services. This includes some basic biographical information, such as name, address and, importantly, their legal status, Massachusetts officials said.
Massachusetts is among 22 states that sought to keep ICE from viewing those records. A court injunction in August had blocked the Centers for Medicare & Medicaid Services from sharing those records with ICE, but then on Dec. 29 a federal judge issued a more scaled back order. While ICE still can’t view medical records of US citizens or immigrants with lawful status in any of those states, it can now see some information about undocumented immigrants, including names and addresses.
The Massachusetts attorney general is still litigating the case, a spokesperson said Wednesday.
One of New England’s largest immigrant advocacy groups called the change “catastrophically dangerous.”
“This will have a deeply chilling effect on people’s willingness to see a doctor, leading quickly to deeper delays and overcrowding of emergency rooms and higher health care costs for all Americans,” the Massachusetts Immigrant and Refugee Advocacy Coalition said in a statement.
Citing pending litigation, the federal Centers for Medicare & Medicaid Services did not comment on whether it had shared such information with ICE.
The real impact of the recent court order may be relatively limited, said Andrew Cohen, of the legal aid group Health Law Advocates. Even undocumented immigrants usually have some footprint in federal records beyond Medicaid enrollment that ICE already can view, Cohen said.
“Where the feds already have their information, this isn’t necessarily going to pose any additional risk,” Cohen said.
But the decision is expected to heighten anxiety among documented immigrants whose data isn’t at risk of being shared. Throughout 2025, operators on a help line run by Health Care for All, a Boston-based advocacy organization, received calls from immigrants either reluctant to enroll in Medicaid or wanted to cancel their membership, said Hannah Frigand, senior director of the organization’s help line and public programs.
“For people to be scared to access things they are qualified for, it’s really concerning,” Frigand said.
MassHealth said its overall membership, including US citizens and immigrants, declined by 6 percent over the 12-month period through October. MassHealth did not attribute the decline directly to immigration enforcement, nor does the agency track why people cancel enrollment.
Nonetheless, others said the numbers are meaningful.
“The MassHealth caseload decline is the best leading indicator we have that something is amiss,” said Christina Severin, chief executive of Community Care Cooperative, which provides health plans for patients of Federally Qualified Health Centers.
Adding to pressure on immigrants, the Trump administration is considering changes to the “public charge” test certain immigrants must take to apply for a visa or green card. The government can deny people legal status based on a finding that someone would rely heavily on public aid.
It’s unclear what standard the Trump administration will use, but the Department of Homeland Security wants the government to have greater discretion in determining which public benefits would bar people from receiving lawful status.
Bartlett, of the New Bedford Community Health Center, said the anxiety is not new to her city, which was the site of the state’s largest immigration raid in 2007, when 361 workers were arrested at a textile factory.
Now, she worries about new policy changes that could further restrict access. In June, federal HHS moved to block undocumented immigrants from receiving certain public benefits, including care at community health clinics. Massachusetts and 25 other states have sued to block the change.
“If that were to go through, we’d have to validate if someone was a legal citizen to receive treatment, and that would change the game entirely,” Bartlett said. “Many people will end up in the ER because we will have to turn them away.”
In her more than 50 years of being a nurse, this would be the first time people would not be able to receive care at a community clinic, she said.
Sarah Rahal can be reached at sarah.rahal@globe.com. Follow her on X @SarahRahal_ or Instagram @sarah.rahal. Jason Laughlin can be reached at jason.laughlin@globe.com. Follow him @jasmlaughlin.
