A Tragic, Deadly Denial

I read your article in The Washington Post about the woman whose Humana policy required prior authorization for a drug she’d been taking (Bill of the Month: “She Struggled To Get a Lifesaving Drug Even After Insurers Vowed To Help,” June 29).

My husband, Kenney, had chronic obstructive pulmonary disease. On June 7, he fatally shot himself after a COPD exacerbation event.

His pulmonologist had prescribed two new nebulizer prescriptions on June 2. One was a specialty medication that would come directly from the drug company. A couple of days later, we called Walgreens to see why the other one hadn’t been filled. Turns out it required prior authorization.

Why the doctor who prescribed it needed to tell his health insurer that he really did think his patient needed it, I will never understand. The pharmacist said she would send the request to the doctor. And why she hadn’t already done that, again, I do not understand. By June 7, of course, it still wasn’t filled.

That day, a Sunday, Kenney experienced the flare-up when I was out mowing the yard. How terrifying it must have been for him to be unable to breathe and me not being there at least to hold his hand. That night he killed himself, leaving a note saying that he hated to leave me but that he couldn’t keep living like that — with the constant anxiety of not knowing when he wouldn’t be able to draw a breath.

Not long ago, a “welcome” packet came in the mail about the other nebulizer treatment — 25 days after it had been prescribed.

Admittedly, my husband’s health was not great. He did have COPD, but we still went out to eat once in a while, and he didn’t have to take his oxygen on those trips. He rarely used it just walking around the house.

He did make a serious suicide attempt six years ago (our daughter and granddaughter had died), but after seeing what it did to me and our son, he promised he’d never do it again. It was only when these exacerbation/flare-up events started this year that he indicated life was getting bad.

Perhaps, just perhaps, if he had received both medications in a timely manner, he would be here today, and we would have had many more years together. We met when we were 16 and had been together ever since. He was 78 when he died.

— Cindy Clements Blewett; Kyle, Texas

Navigating GLP-1 Coverage

Sydney Lupkin’s thoughtful article about the obstacles in obtaining weight loss drugs was interesting (Healthcare Helpline: “Trouble Getting Weight Loss Drugs Covered by Insurance? Here’s What To Know,” June 26). It would have been more helpful had it included a discussion of Medicare’s decision to cover these drugs as of July 1, 2026, and how to navigate the rocky shores of obtaining a prescription that won’t be denied.

— Sharie Hartman; Manteca, California

Beyond the Veil of Pregnancy Centers

I would like to address the article about a pregnancy resource center providing prenatal care in Sandpoint, Idaho (“Religious Anti-Abortion Center Finds Opportunity in Town Without OB-GYNs,” May 20). It is unfortunate that many still do not understand what pregnancy resource centers do, nor the high-quality care they provide. While there are some “crisis pregnancy centers” that provide limited offerings, most centers are aligned with a national organization like the National Institute of Family and Life Advocates, the Heartbeat Pregnancy Center, or Care Net. All these organizations require centers to have a medical director (a licensed healthcare practitioner) and require that the nurses who perform the ultrasounds have appropriate training. While I am not affiliated with 7B Care Clinic, I am concerned that the article may not have accurately reflected what is provided in such clinics. I offer my experiences to bring further clarity.

I work at a life-affirming women’s clinic. I am a board-certified family physician. I have delivered approximately 1,000 babies in my career. I have been performing ultrasounds for my patients for over a decade, and fought for this ability under the scrutiny of maternal-fetal medicine specialists, spending time alongside their registered diagnostic medical sonographer technicians, and having my scans reviewed by maternal-fetal medicine physicians. I have practiced medicine in three states over three decades.

Second, while I am life-affirming, I am not “anti-abortion.” I happen to believe that there are better choices, and I know that some women will still choose abortion, even after hearing all their options. I will gladly see those women for follow-up to answer questions and evaluate for complications — something that the abortion clinics in my area apparently will not do. I say this because that is what the women I see tell me. The clinic that performed the procedure or gave them the pills will not see a patient after the abortion for any follow-up. I have always willingly seen patients for any reason, whether I was working at a private clinic or hospital-owned clinic. That is no different now that I work for a life-affirming women’s clinic.

We provide a variety of services — free of charge. We are also stepping up to provide prenatal care up to 20 weeks because there is a shortage of obstetrical clinicians in our county. We encourage women to see a clinic where they can be followed throughout the entire pregnancy, if possible, and we are in no way marketing ourselves as competition. We are stepping in to fill the large gap that exists.

Just because the clinic in Sandpoint chooses to respect life does not make it a fake clinic. This clinic seeks to bring in physicians to provide prenatal care. They are bringing in OB-GYNs from Washington state, which has no restrictions on abortion. With this information taken into consideration, I ask you to reconsider any concerns about a clinic bringing board-certified OB-GYNs into an area where there is a shortage.

— James Heid, Vancouver, Washington

The Root of All Good

The article Claudia Boyd-Barrett wrote about how immigrant parents’ arrests are creating a mental health crisis for children was moving and brought awareness to the mental health challenges faced by them (Growing Up Scared: “Arrests of Immigrant Parents Create Mental Health Crisis for Children,” June 18). It was important to note how every story was different but focused on how much children missed and yearned for their parents to come back home. You also wrote about how it affected them by not having a parental figure in the home. That really touched me. Specifically, Jacob’s story and when he listed all the things he missed about his mom but especially being close to her.

I am currently a master’s student in social work working to become a better ally to the Hispanic immigrant community. I’ve seen how being afraid and sad over the immigration policies has affected my friends in this community. Losing a close parent and not being able to have that security with them anymore is hard to go through, and trauma affects children as they grow.

In this article, you have recognized the worth of a person, which is a core principle in social work. These children are worthy and have the right to feel taken care of and secure.

I would love to see more mental health services accessible to immigrant communities and their families. This would benefit children as they learn to cope with their feelings and how to make sense of a new world.

— Stacy Xiong, Athens, Georgia

Bagging a Bargain

Author Susan Jaffe mentioned GoodRx in the article “Thousands of Medicare Beneficiaries Thought Their Drug Plan Was Free. Then They Lost It” (July 7), but she failed to mention a much better discount drug site, Mark Cuban’s costplusdrugs.com, where a 90-day supply of 2.5 milligrams of rivaroxaban, a generic for Xarelto, is available for under $50. This could help the thousands of people who lost coverage through unpaid premiums from Wellcare Value Script obtain their medications. The problem of yearly increasing penalties for losing Part D coverage is something that has to be addressed by the Centers for Medicare & Medicaid Services.

Thanks to ³Ô¹Ï²»´òìÈ for the relevant coverage.

— Jackie Button; Miami

Fleshing Out the Details

Your report identifying alpha-gal syndrome as a red meat allergy is accurate in that respect but inadequate in its breadth (“Would Hunters Take a Lyme Disease Vaccine? We Asked,” June 30). Alpha-gal is an allergic reaction to virtually all mammalian products. If you explore that, you’ll find an interesting story, as mammalian products are everywhere, including in pharmaceuticals, cosmetics, and other non-meat products. Alpha-gal is growing rapidly, and too many people, including doctors, do not realize that AGS is far worse than just a red meat allergy.

I suggest you help build understanding of the threat by describing the allergy in the future as an allergy to mammalian products. If you do not think your audience will understand that term, perhaps you can explain that it includes pork and anything derived from animals with hooves. As a former and now retired reporter, I encourage you to cover this allergy because its implications are surprising and scary.

— John Varner, Surry, Virginia

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .

It’s a heightened concern for the estimated who are U.S. citizens or legal permanent residents, as new work requirements kick in for the federal-state healthcare program that serves low-income and disabled Americans.

Starting next year in most states, many adults enrolled in Medicaid will have to prove they work, are enrolled in college or vocational courses, volunteer, or do unpaid work for at least .

Advocates say this could pose a significant challenge to Medicaid-eligible farmworkers, who frequently work more than 80 hours a month during harvest season but less in other months. What’s more, outside the harvest season, many workers take on informal jobs in construction, landscaping, or home repair for which they don’t receive formal paychecks that would prove their continuing Medicaid eligibility. Still, they can establish eligibility if they prove their average monthly income over six months is equivalent to at least 80 hours of work at the federal minimum wage.

“Having a work requirement — having to create more paperwork and more proof — is certainly extremely challenging for farmworkers and others who are low-income and who may especially have seasonal jobs, not year-round, and do have periods” when there is no work available, said Alexis Guild, vice president of strategy and programs at .

New Requirements, Additional Hurdles

Agriculture is a , and Americans to put food on their tables. Nearly 60% of those workers are U.S. citizens or green-card holders, according to the . The remaining 40% lack legal status or are otherwise ineligible for Medicaid.

Even among farmworkers with citizenship or legal status, the uninsured rate is three times that of the general population, and most farmworkers with insurance are Medicaid beneficiaries, although participation rates vary by state. According to a , 71%-79% of eligible farmworker households report participation in Medicaid.

The new Medicaid work requirements were a key provision of the One Big Beautiful Bill Act signed last July by President Donald Trump. Under the federal law, and the District of Columbia must implement the requirements by Jan. 1. A few states have the work rule early.

The 80-hour rule applies in states that expanded Medicaid, a process that began in 2014 and was tied to the Affordable Care Act. Following the initial expansions, agricultural workers with legal documentation became to have health insurance, according to a 2021 article in the American Journal of Agricultural Economics.

Immigration Anxieties

The work requirements are the latest in a long list of obstacles placed between workers and the healthcare they’re legally entitled to, Guild said. “Medicaid certainly helps because it alleviates the cost issue,” she said. “But there are still other barriers, such as transportation, taking sick leave, and finding time to visit a health center. All these factors can prevent them from actually receiving medical care.”

For farmworkers with green cards and naturalized U.S. citizens, there is another source of stress: the fear that signing up for Medicaid could put personal information in the hands of immigration authorities.

That’s what worries Luis, a 45-year-old green-card holder and Medicaid recipient who dreams of becoming a U.S. citizen. Luis — who asked to be identified by only his middle name — lives with his wife and daughter in North Carolina, where he has worked in agriculture for nearly a decade.

Speaking in Spanish, he said that when he learned about the work requirements, he knew it would be challenging for him to prove that he works 80 hours a month. “I only work on farms for six or seven months; the rest of the year I work in whatever I can find,” he said.

Republicans in Congress argue that work requirements will reduce federal healthcare spending, encourage nondisabled adults to , and preserve safety net resources for the most vulnerable populations.

Among Hispanic adults enrolled in Medicaid, 67% are already working, according to a 2025 .

The Centers for Medicare & Medicaid Services did not respond to requests for comment for this article. But in June, when its “nationwide framework” to implement the Medicaid work requirements, Administrator Mehmet Oz said it would help beneficiaries “build skills and independence through work, education, job training, or community service, creating new opportunities for themselves and their families.” Federal officials say the new requirements “could reduce poverty by as much as 2.9 million people.”

Chronic Illness

Agricultural work is one of the nation’s , and it is associated with and , including respiratory conditions. A found that 37% of male farmworkers and 47% of female farmworkers in the state had at least one chronic health condition. The new work requirements present one more barrier for those seeking care, advocates said.

“People skip checkups and screenings, and conditions that could be caught early and treated cost-effectively” aren’t, said Adriana Cadena, executive director of .

Emergency rooms often become the “natural” place to go for healthcare, Cadena added. “This drives up waiting times and costs for all of us. … And when people are sick enough that they miss work, it starts a vicious cycle of lost productivity and family economic instability that again threatens all of us.”

A Loss for Families and Children

The new federal rules also require beneficiaries to verify their eligibility at least twice a year, twice as often as previously, creating another potential obstacle.

“Letters can easily be missed, and forms may go unfilled. If people get caught up in the paperwork, they could lose coverage,” said , an assistant vice president at , a nonprofit that promotes an equitable healthcare system.

For farmworkers who travel from state to state, the process can be especially difficult.

“You have to find the time to transfer your coverage and probably find a person or organization that can help you — and that can be really hard when you’re constantly moving,” Cadena said.

The situation highlights the difficulties of navigating a complex system for individuals and families already struggling to make ends meet.

“The result,” Cadena said, “could be the loss of coverage not only for workers, but also for their families and children.”

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .

Now, Democrat Xavier Becerra and Republican Steve Hilton present a stark choice to voters in the race to be the next governor at a moment when public support for the state’s generous safety net is starting to fray.

Both frame the choice as an economic one.

Becerra, former secretary of Health and Human Services under President Joe Biden, has to exclude the poorest immigrants from routine care and push them into expensive emergency rooms . Hilton, a conservative commentator backed by President Donald Trump, has promised to eliminate their coverage and has echoed national Republicans who have to bolster their claims of fraud and abuse in the Medicaid program.

With voters nationwide worried about inflation and the rising cost of living, some Californians might feel less inclined to provide full healthcare coverage to those lacking legal status. What the state does next could have profound implications for its healthcare system and sprawling economy.

Over the past decade, California lawmakers used state dollars to expand Medi-Cal, offering all low-income residents comprehensive coverage regardless of immigration status. But enrollment surpassed initial projections, as did the cost. Medi-Cal coverage of immigrants without legal status costs the state roughly , according to California’s nonpartisan Legislative Analyst’s Office, more than double the initial estimates.

California lawmakers and Democratic Gov. Gavin Newsom, who , have approved major rollbacks of benefits for those residents. They said the state can’t afford ballooning healthcare costs amid massive federal cuts from the GOP tax-and-spending law known as the One Big Beautiful Bill Act; the California Health and Human Services Agency projected up to 3.4 million Medi-Cal enrollees and the state could lose more than $30 billion a year in federal funding under the law, causing major disruptions in the safety net health program.

Medi-Cal’s budget for the 2026-27 fiscal year is $217 billion, and the program serves more than 14 million Californians.

Meanwhile, many legal U.S. residents and citizens have seen their health premium payments skyrocket this year after Congress let enhanced federal Affordable Care Act subsidies expire at the end of December.

As the state grappled with a deficit last year, a majority of likely voters in California said — for the first time in nearly a decade — that they opposed providing health insurance to immigrants without legal status, by the Public Policy Institute of California.

“The state faces major challenges, and healthcare is one of the major expenditures,” said Mark Baldassare, PPIC survey director. “People have become more selective about how they want to see those limited healthcare dollars spent.”

Hilton, running on a platform of affordability and lowering taxes, has seized on the sentiment, casting health coverage for immigrants without legal status as and a to the state’s ability to help citizens.

“Stop taking money from California taxpayers who can barely afford their healthcare to give free healthcare to citizens of other countries who shouldn’t even be here,” Hilton said in a the morning of the June 2 primary.

In campaign stump speeches, to use the savings to for other Californians without detailing how. Hilton did not respond to requests from ³Ô¹Ï²»´òìÈ for comment.

“Their messaging is very, very simple: It’s an us vs. them,” said Roger Salazar, a Democratic political consultant who represents a coalition of healthcare advocates who argue providing coverage to people who can’t afford it strengthens the workforce and, as a result, the economy. “It’s just a question of convincing the average voter that it’s much better economically.”

A son of immigrants, Becerra for decades pushed to in Congress and has made a similar pitch in his campaign for governor. He did not respond to requests for comment.

“Immigrants, whether documented or not, work hard. They pay taxes, and sometimes they get injured on the job or their children get sick,” during a debate in May. “It would be foolish to tell a family that they don’t have access to the pediatrician or the family doc.”

Becerra, who could become California’s first elected Latino governor, when Newsom and legislative leaders decided to for adults without legal status, cut benefits, and impose monthly premiums.

“Stop treating coverage as a budget variable that expands in good years and contracts when revenue dips,” Becerra wrote in May in response to an Orange County Register . He has new, steady revenue to fund basic services, such as by upping taxes on corporations and the wealthiest Californians.

In 2023, California was home to about 2.3 million people without legal status, representing of the state’s labor force, according to the . And live in a family that includes at least one member without legal status, according to the California Department of Education. Healthcare economists say giving people access to preventive healthcare saves taxpayers money in the long run by and relieving pressure on an overburdened system.

That, Baldassare said, wasn’t a hard argument to make during the covid pandemic, when immigrants were and the link between individual well-being and public health .

But Medi-Cal costs to cover roughly 1.4 million immigrants , according to the latest estimates from the Department of Health Care Services. Because only some lawfully present immigrants are eligible for federal Medicaid benefits, states like California must do so exclusively with state funding.

California’s budget experts that maintaining full Medi-Cal coverage for immigrants without seeking additional revenue would destabilize the state’s long-term fiscal outlook.

In a legislative hearing last year, Republican Assembly member Carl DeMaio questioned whether California taxpayers would prioritize the expansions, saying he doubted “illegal immigrant healthcare in the general fund would be at the top of their list.”

After lawmakers approved the spending reductions, support for immigrant health coverage dropped, Baldassare said. Democratic lawmakers and Newsom  several Medi-Cal cuts until July 2027, leaving decisions for the next governor.

David Hayes-Bautista, who has spent his career studying the economic contributions of Latinos and immigrants, said Californians without legal status and tend to work in industries and occupations that . As a result, many resort to Medi-Cal, saddling the state with the healthcare costs instead of employers.

“California, as a state, has the world’s fourth-largest GDP, which is true thanks to Latinos,” said Hayes-Bautista, director of the Center for the Study of Latino Health and Culture at UCLA. Without contributions from Latinos, many without legal status, it drops to eighth place, about the size , he added.

Immigrant advocates hope to have a more vocal champion in Becerra, the favorite to become governor in a state where Democrats outnumber Republicans nearly 2-to-1.

“He will fight, he will push back, he will do all that he can,” said state Sen. María Elena Durazo, a former labor leader who has championed the immigrant healthcare expansions. “That’s the most we could expect.”

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .

³Ô¹Ï²»´òìÈ senior correspondent Julie Appleby discussed the high cost of healthcare and the political fallout on WAMU’s 1A on June 30.

• .

³Ô¹Ï²»´òìÈ senior correspondent Renuka Rayasam discussed the public health concerns around a planned immigration detention center in Georgia on WUGA’s The Georgia Health Report on June 26.

• .
• Read Rayasam’s “A Trump Stronghold Grapples With Health Risks of ICE Detention Sites.”

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .

His aunt sat at the dining table, sobbing. His father, who’d walked him to the bus stop that morning and promised to take him to dinner when he got back, wasn’t there.

Saúl Zermeño, a 45-year-old single dad, had gone to a routine check-in appointment at an Immigration and Customs Enforcement office that morning, a requirement he’d complied with for years. The father had deferred action that allowed him to stay and work in the U.S., according to his attorney. But that day, Oct. 3, officers deported him to Mexico, where he hadn’t lived since he was 9 years old. Zermeño had been Damian’s sole caregiver since he was a baby because his mother chose not to be involved in the boy’s life, the family said.

Suddenly, Damian, who was born in the U.S., found himself separated from his father by thousands of miles and a heavily guarded border. The previously cheerful 10th grader, who doesn’t have a driver’s license and can make a few basic dishes but isn’t used to cooking for himself, faced navigating his teenage years alone, his dad’s presence reduced to a two-dimensional image on his phone.

“I thought it wasn’t true,” Damian said. “I just went to my room. I didn’t want to leave. I didn’t even want to eat.”

Damian is among an estimated , most of them U.S. citizens, separated from a parent by the Trump administration’s deportation policies. Their mothers and fathers have been deported or locked for months inside detention centers, often from where their families live. These children are separated, , from the adults they depend on. Parents have been arrested while , , and at immigration check-ins with their children present. Most people detained have . (Being in the U.S. without authorization is typically a civil offense). With their parents gone, kids’ lives are plunged into fear and uncertainty.

As a result, a generation of children from immigrant families are exhibiting mental health problems that could .

Parents, therapists, and others who work with immigrant families said they’ve already encountered preschoolers with speech delays, elementary school children who talk of suicide, and teenagers too anxious to leave the house. Research has shown repeatedly that separating children from their parents . The stress of losing a primary caregiver creates havoc in a child’s brain and body, increasing their risk for mental and physical health problems, including depression, anxiety, post-traumatic stress disorder, a weakened immune system, and developmental delays.

“You can just see it in their faces; it’s almost like the light has been dimmed in their eyes,” said the Rev. Tanya Lopez, a pastor at Downey Memorial Christian Church who regularly visits immigrant families as part of a made up of Los Angeles-area religious leaders.

The health risks from this stress response are long-term. People who experience parental separation and other traumatic events as children are heart disease, diabetes, cancer, and other chronic conditions as adults.

In a statement, the Department of Homeland Security said ICE does not separate families, and that parents are asked if they want to be removed from the country with their children or to designate a safe person for them to stay with in the U.S.

However, by the Women’s Refugee Commission and Physicians for Human Rights found that many parents aren’t given that choice, and that ICE often doesn’t ask detainees if they have children or take steps to ensure that children left behind are safe. Saúl Zermeño said ICE officers didn’t ask about his son or check on Damian’s well-being when he was deported.

For days after his father’s deportation, Damian didn’t want to leave his room, eat, or go to school. He stopped talking to his friends. He stopped playing his favorite video game, Fears To Fathom. When he returned to school a week later, the teenager would cry in class or walk out overwhelmed with sadness. Even his favorite subject — English — lost its appeal.

Damian and his father were inseparable; family members joked that they never saw one without the other. Zermeño took Damian, who has attention-deficit/hyperactivity disorder, autism, and other health conditions, to his medical appointments. He cooked for him and combed his hair. He loved to take Damian to his favorite Thai restaurant or to get boba drinks after school. As much as they joked around and played pranks on each other, Zermeño also taught Damian the importance of work by bringing him along to construction jobs and to find supplies at Home Depot.

Damian used to get annoyed with his father’s motivational chats about responsibility. Now they’re one of the things he misses most.

“I thank my dad every day for teaching me to be strong before he left,” Damian said.

Elsewhere in Los Angeles, Jacob, a shy 9-year-old with cropped, curly hair, skinny limbs, and a serious expression, was missing his mom. On a Saturday in May, he clung tightly to his father’s hand as they walked among homeless people, street peddlers, and the stench of urine that hangs in the air outside the building where they live in a cramped apartment. He hoped his mom would soon be released from immigration detention so that he could hug her again.

“If my mom was here, I’d be happy,” he said. “Right now, I’m not.”

Jacob is in some ways a typical 9-year-old. He likes playing Roblox and Street Fighter. He dreams of becoming a police officer and of owning a guard dog, “because you can train them and they defend you.”

But he also endured a harrowing journey, even before being separated from his mom in January. Jacob’s family fled their home country of Colombia in 2024 because members of a paramilitary group threatened to kill them, his father, Andreis, said. During their journey to the United States, Jacob saw dead bodies while trekking through the jungle, was kidnapped and robbed at gunpoint with his parents, witnessed a rape, and had to sell candy and beg for money, his dad said. ³Ô¹Ï²»´òìÈ is not using the father’s or son’s real name because the family fears it would jeopardize their asylum cases.

After the family arrived in Los Angeles, Jacob suffered from nightmares and an intense fear of being alone. He started to recover once he began attending school and got connected to therapy through the school district, his dad said. For a short while, the family felt they had found peace.

Then, immigration officers detained Jacob’s mother at a check-in appointment while he and Andreis sat in the waiting room. The mother has a pending asylum application and no criminal record, Andreis said. The father said he and his son broke down when officers informed them of his wife’s detention, handing them a bag with her wallet and cellphone. They returned home without her, leaving Jacob inconsolable.

“He was terrified,” the father said, fighting back tears, his voice growing quiet as he recounted that moment. “He was crying with rage.”

After that, Jacob didn’t want to eat or go to school. When he went to school at his dad’s insistence, his teacher called home to ask why he was crying in class. Jacob couldn’t sleep. He acted out. He blamed his dad.

“When will my mom come back?” he asked his dad. “Why do they have my mom? I miss my mom.”

At the same time, Andreis said, he was going through his own crisis, trying in vain to console his son while wrestling with grief, worry, and desperation over what happened to his wife. He stopped his work as a laborer for two weeks to take care of Jacob, but that created financial stress and meant he sometimes couldn’t afford to fund his wife’s commissary account so she could buy better food and make phone calls. Jacob lived for those phone calls.

Jacob listed all the things he missed about his mom, including her cooking (rice with meat, corn cakes with egg), visiting the park together, and her taking him to get his hair cut, treating him to McDonald’s on the weekend, and bringing him to church. Most of all, he missed being close to her.

“I would lie down with her, and I’d watch videos with her,” he said. “My mom would hug me and I’d hug her.”

Sometimes he sprayed her perfume on himself so he could smell her.

After almost five months at the Adelanto ICE Processing Center, Jacob’s mother was released based on a habeas corpus petition in May. The family is still living in fear of detention or deportation. The father worries he too could be detained, and what that would mean for Jacob. Andreis is currently appealing a removal order for the two of them.

A published by the Brookings Institution estimates that over 200,000 children — including 145,000 U.S. citizen children — have likely had at least one parent detained since President Donald Trump returned to office. About a third of those children are under age 6. The number of children with detained parents is expected to grow as the federal government pours over $200 billion into immigration enforcement, including funding from the GOP’s and a appropriation Trump signed this month.

More than 4.6 million U.S. citizen children live with a parent at risk of deportation, according to the report.

Families Broken

Noemi, a Guatemalan mother and asylum seeker, stood in the parking lot at an ICE office north of Los Angeles, her three children wailing and clinging to her, glass from the family’s car scattered at their feet.

Moments earlier, immigration agents had smashed a window and forced her partner out of the car while he waited for Noemi and the kids to finish a check-in appointment. While they were inside, officers tried to separate Noemi from the couple’s children, ages 9, 7, and 1, but gave up after the kids started screaming, Noemi said. Meanwhile, her partner, a Mexican national who’s lived in the U.S. for almost 20 years, was sent to the ICE detention center in Adelanto.

“It was something tragic, something inexplicable that happened that day,” said Noemi, who asked to withhold her full name because she fears government retaliation for sharing her story. “It’s something that marks you for your whole life. My family was broken.”

Located in the Mojave Desert, the privately run Adelanto ICE Processing Center is the immigration detention center closest to Los Angeles and in the U.S. It held a daily average of as of April, and a facility next door called the Desert View Annex held an additional 426.

Since her partner’s detention in December, Noemi said, their children haven’t been the same.

Her 7-year-old daughter, till then usually happy and smiling, became depressed and refused to eat. Her once-high grades plummeted, and she forgot the names of letters and numbers in both English and Spanish. She and her 9-year-old brother struggled to sleep and asked constantly about their dad, wondering if he was taken because they’d done something wrong.

“Why is this happening to us?” they asked her. “We’re good. We’re studying.”

Noemi’s youngest daughter went back to crawling for three months, even though she’d already learned to walk before her father was taken. The little girl would cry out in her sleep, “Pa! Pa!”

Sofia Mendoza, a therapist who works with immigrant families at a community clinic in Los Angeles County, said separated children can experience a form of grief. It’s hard for them to come to terms with their parent’s absence because the parent is still alive, but not with them. This can disrupt the child’s bond with that parent and their ability to form trusting relationships in the future, she said.

Many children also become extremely anxious, angry, and fearful, Mendoza said. Young children often complain of physical symptoms such as stomachaches, develop separation anxiety, and regress to earlier behaviors like bed-wetting. Older children may have panic attacks, nightmares, and difficulty focusing, Mendoza said. Caregiver loss is also associated with and substance use in children.

Norma Gómez, a project manager for the Mixteco Indigena Community Organizing Project in Oxnard, said after immigration raids shook the community last summer, her 9-year-old daughter refused to go to school for a week and was afraid to leave her mom and dad, even though they’re legal U.S. residents. She’d seen other kids at school crying because family members had been detained. Gómez showed her daughter their U.S. residency documents to reassure her. The child asked to make copies for her classmates, hoping they would protect them too.

‘Time To Be an Adult’

Back in East Los Angeles, Damian is living with one of his aunts and struggling to adapt to not having his father around. He said his grades have dropped because he can’t focus in school. He no longer wants to do things he used to enjoy with his dad, such as going out to eat.

“Fun is over,” he said. “It’s time to be an adult right now.”

Being without his father has forced Damian to become more independent, he and his aunt Claudia Zermeño said. Before, his dad did almost everything for him. Now, Damian does his own laundry, helps with housework, and styles his own hair. He’s protective of his aunts, who are both devastated by their brother’s absence; he hugs them frequently and tells jokes to try to cheer them up. He doesn’t want to upset them more by showing his own sadness.

Damian receives therapy both in and outside of school. He said he’s learned breathing exercises that have helped, but he still feels sad and worried a lot of the time. Sometimes he feels angry.

“I try my hardest to think, to stay focused,” he said. “But with everything that’s going on, I can’t keep the facade of ‘everything’s normal’ when I feel heartbroken.”

Saúl Zermeño, now living in Guadalajara, said he’s worried about his son’s health. Damian has a genetic condition called , which causes tumors to grow on nerve tissue in his body, including one in his head that, if not checked regularly by a doctor and monitored by his family, could interfere with his brain. He also suffers from epilepsy and was born with only one kidney, which means he tires easily and doesn’t play sports. Saúl is afraid his son won’t get the care he needs without him there. As Damian’s legal guardian, Claudia Zermeño is doing everything she can for him, but she has two children of her own and is also caring for her mother, who has neurological problems from a stroke.

Damian talks with his dad as often as he can. He hopes to visit his father in Mexico, but he doesn’t have a passport and, as a minor under 16, there are more requirements to get one without his dad present. Saúl is working with an attorney to get permission to legally return to the U.S., but the process is complicated and uncertain.

So, for now, Damian’s hanging on to hope that his dad will be allowed to return and is trying to become the man he believes he should be. He’s making plans to get his driver’s license when he turns 16 this month. He’s given up his goal of going to college and instead wants to get a job right after high school to help his aunts and send money to his dad.

He still cries, but only when he’s alone in his room.

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .

Hundreds of detainees across at least 33 states allege in federal suits that immigration detention facilities are failing to provide adequate medical care, an investigation by ³Ô¹Ï²»´òìÈ and The Associated Press found. Detainees say they didn’t get medications on time — or at all — for conditions including high blood pressure, diabetes, depression, epilepsy, Parkinson’s, and HIV. Requests for help went unanswered for weeks. Blood sugars rose. Infections festered. Cancers remained untreated. Detainees collapsed and had seizures.

U.S. jails and immigration detention centers have to meet the medical needs of the people in their charge. But the system is sagging under an influx of detentions since President Donald Trump returned to office: More than 75,000 immigrants were being detained by U.S. Immigration and Customs Enforcement , up from around 40,000 a year earlier.

³Ô¹Ï²»´òìÈ and AP analyzed thousands of court cases filed since Trump’s second inauguration that use a legal route known as habeas corpus to argue people are being held illegally by ICE. The records offer a rare window into how those detained say, often under penalty of perjury, ICE is handling their medical needs. Reporters also interviewed more than 50 detainees, family members, and lawyers.

The investigation revealed that medical neglect is alleged across the sprawling detention system, including in offices not designed to house people, county jails, and quickly staged sites with nicknames such as “Alligator Alcatraz.”

ICE custody is deadlier than it has been in two decades, researchers wrote in April. The Department of Homeland Security reported 51 people had died in detention since the start of Trump’s second administration — with suicides .

³Ô¹Ï²»´òìÈ and AP asked DHS to respond to the findings six days before publication, but it did not provide comment. The department’s acting chief medical officer, Sean Conley, has “it is both policy and longstanding practice for aliens to receive timely and appropriate medical care from the moment they enter ICE custody” and that the agency recruits healthcare professionals to maintain high standards. “This is better, more responsive healthcare than many aliens have ever received in their entire lives,” he has said.

Individual facilities and private prison companies contracting with DHS that responded to requests for comment said they follow ICE standards and detainees receive medical care when it is required. Some said they were unfamiliar with the allegations outlined in court documents; others blamed some detainees for lapses in their medical care.

“I have never seen such disregard or medical neglect like this anywhere,” Vardan Gukasian, a political dissident and former paramedic who spent years behind bars in Armenia, wrote in in March to contest his detention in Henderson, Nevada, as it stretched to 13 months despite health problems.

Madeleine Skains, a spokesperson for the city of Henderson, said medical care is always available at the facility and that the court had not ordered changes to his care.

Last June, as Gukasian experienced the symptoms of uncontrolled high blood pressure — dizziness, a nosebleed, and a headache — his cellmate banged on their door for help.

“When it did not arrive, the rest of the block banged on their doors,” he wrote. Gukasian was hospitalized that day.

‘Brazen Indifference to Really Obvious Problems’

The administration’s mass deportation effort has swept up during routine immigration check-ins, at traffic stops, at their homes, and in hospitals.

About have no criminal conviction. Their immigration proceedings are civil, not criminal.

“I couldn’t understand why they treated me so harshly,” said a father of six in Georgia. He said he was injured while shackled in custody when the vehicle transporting him to an Atlanta facility jolted, throwing him out of his seat and into a metal armrest. His wound became infected with E. coli, he said, because he had to sleep on a dirty concrete floor amid leaking toilets.

Like other detainees interviewed, he spoke on the condition of anonymity; they said they fear for their safety, for the safety of their families, or that speaking out would jeopardize their immigration cases. The AP and ³Ô¹Ï²»´òìÈ are not naming anyone identified in court documents without their consent.

Staffers at Stewart Detention Center in rural Lumpkin, Georgia, didn’t adequately respond to that man’s request for medical help, , until he passed out and was taken to a hospital about an hour away. There, he said, a doctor told him he’d narrowly escaped amputation of his left leg. Medical staff found no records of a case matching this description, according to Brian Todd, a spokesperson for CoreCivic, which runs the facility.

The 48-year-old, who moved to the U.S. from Guatemala more than two decades ago, was released in October and is now a legal permanent resident. But he is unsure if he’ll be able to return to his job in construction because, he said, he can no longer lift heavy things due to his injury.

Some detainees or their lawyers said even basic care was denied: gauze to protect an open foot wound, prenatal care for a high-risk pregnancy, a pillow to ease the pain of sleeping with advanced stomach cancer, sanitary pads for postpartum bleeding.

“I would like to believe the government has the best interest of those it holds in detention for whatever period of time,” Judge Benita Pearson, a federal judge in Ohio, said during a hearing in October concerning a 70-year-old who alleged the government lost her glasses during her arrest. “If one is unable to see due to the loss of glasses when detained, that should be fixed.”

, who worked for ICE and now serves as a special adviser to the American Bar Association, said case law requires the government to treat people in immigration detention with the same care it affords those in traditional jails awaiting trial. But administrators are granted discretion and medical care standards vary.

Detainees are frequently moved across the country, often without warning, interrupting treatment. A woman from El Salvador said she missed a week of HIV medication when she was transferred from Colorado to a county jail in Wyoming.

A Russian man wrote that, while detained in Texas, he saw a gastroenterologist about his painful gallstones and scheduled an appointment with a surgeon. “Unfortunately, I never got to see him, due to my being moved around various detention centers.”

Advocates say that even obvious disabilities, like legal blindness, are ignored.

A detainee who lost one eye and had severe glaucoma in the other required twice-daily drops to maintain what vision remained. But, he said, some days the drops never came.

“Now I can only see a little bit straight in front. It now often looks like I’m seeing through gauze,” the man wrote in a court declaration. “This makes me very afraid that one of these times I am going to open my eyes and not be able to see anything at all.”

He wrote that he was scared he wouldn’t be able to see his infant son grow up.

“It’s just sort of brazen indifference to really obvious problems, things you would have thought absurd a decade ago — like the fact that you can’t see,” the man’s attorney, Brian Hoffman, said. “Before, you could attempt to work with folks on the government side and maybe shame them into doing the right thing. Now, it’s sort of like anything you want done you have to go to court and sue over.”

Even court orders aren’t always enough. One California judge ordered the government to take a man showing signs of prostate cancer to a specialist for diagnosis and treatment. Records show they did not take him.

Lawyers representing ICE told the judge that officials missed the appointment because of an “internal scheduling error.” CoreCivic, which runs that facility, said it was unable to comment on active litigation.

A Surge in Cases

When immigrants file habeas corpus petitions, they exercise a right to challenge unlawful imprisonment that dates to .

More than 40,000 such petitions have been filed during Trump’s second term, fueled by decisions last year to deny bond to many people held on immigration charges. Judges are split on whether that’s legal; the question appears headed to the Supreme Court.

Many habeas claims , but judges typically cite reasons unrelated to the medical neglect described in the petitions, such as detainees’ being held too long before being deported.

The more than 300 medical neglect claims found in this investigation represent a fraction of the problem. The details of habeas corpus cases are often hidden due to a federal rule barring the public from viewing such documents online. ³Ô¹Ï²»´òìÈ and AP obtained some documents from courthouses and received records on 4,400 cases from , a project of the nonprofit Immigration Justice Transparency Initiative. But tens of thousands more remain largely inaccessible.

Some judges have written that the habeas process is not how to raise allegations of medical neglect and have declined to release detainees over those claims. Not every detainee who believes they experienced medical neglect files a habeas petition or cites their medical issues if they do.

Jose-Antonio Segismundo’s petition made no mention of being unable to see an oncologist for the cancer in his abdomen while detained for more than seven months at the Florida detention facility known as Alligator Alcatraz and Folkston D Ray ICE Processing Center in Georgia. Medical records in his court filings show he was arrested about five weeks before his scheduled appointment with a cancer specialist.

His wife, Maria Jose Gonzalez, said he didn’t receive any treatment even though she sent his medical records and explained his condition to officials at Folkston. When his stomach pain erupted, often suddenly and intensely, she said, they gave him Tylenol.

Geo Group, which runs Folkston, follows ICE standards and provides healthcare and access to off-site medical specialists when needed, spokesperson Christopher Ferreira said.

This spring, Segismundo, 48, was deported to Mexico, a country he left nearly 30 years ago, Gonzalez said. Now, she said, he will have to restart his search for care in the Oaxacan village where he grew up.

Watching Loved Ones Deteriorate

Detainees receiving inadequate healthcare have little recourse. The Department of Homeland Security last year gutted the Office of the Immigration Detention Ombudsman. In early May, it shut the office entirely, arguing that Congress didn’t fund it.

Previously, ombudsman staffers could help facilitate medical care or look into complaints of neglect, according to Matt Boles, an immigration attorney in Georgia. Now, he said, there’s no one to call.

Meanwhile, detainees’ families said they feel helpless, making desperate calls to facilities, the government, and their legislators while watching their loved ones deteriorate.

Riya Khan saw her mother get sicker at the California City Detention Facility, which is owned by CoreCivic. When she visited a week after her mother arrived at the facility in the Mojave Desert, Riya said, the 64-year-old woman stumbled into her seat. She was shaking and her breathing was labored.

Masuma Khan came to the U.S. from Bangladesh in 1997. She has no criminal history, her records say, and was detained in October when she showed up for her regular ICE check-in.

For the month she was detained, according to her daughter, she only intermittently received her medications for conditions including high blood pressure, hypothyroidism, and prediabetes. CoreCivic treats chronic conditions in line with applicable medical standards, Todd said.

“Nothing matters more to CoreCivic than the health, safety and well-being of the people in our care,” Todd said.

Khan said she got her asthma medication for the first time two days before she was released and that her eye drops for glaucoma never arrived. Staffers told Khan she needed to buy some of her medications from the commissary but it didn’t stock them, her daughter said.

Before ICE detained Masuma Khan, she made friends with everyone, her daughter said. She had worked for years at Lucky Boy, an iconic Pasadena fast-food restaurant, and in her free time fed birds and left out fruit for bees that visited her apartment’s balcony.

Now she’s too scared to go outside. She still must regularly check in with ICE, and she’s terrified each time.

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A Stroke on a Video Call

Previously, detainees with serious medical needs would likely have been released on humanitarian parole, in part to avoid the cost of their care, Vermont attorney Andrew Pelcher said.

In fiscal year 2023 — before the detained population soared — ICE spent more than $390 million on healthcare for detained noncitizens, according to its to Congress. In May, Todd Lyons, then acting director of ICE, said at a conference that the agency had already spent “almost half a billion dollars” on detainee healthcare this year.

Now, under “mandatory detention,” people are staying locked up with serious — and expensive — conditions.

A Romanian citizen underwent several heart surgeries, including an emergency triple bypass in April 2025, before he was arrested in July. As part of his recovery, the 52-year-old was required to take 16 daily medications. While at an ICE field office in Baltimore, his court filings allege, he went two days without any medication before officials moved him to a facility in New Jersey.

He was hospitalized three times while detained, complaining of chest pains — in part, medical records and court documents say, because despite “countless requests,” the detention center did not provide all his medications. Hospital discharge papers cited by his lawyer show he received only eight of the 16 medications after his second release from the hospital.

“Can you please talk to the ICE facility to make sure they give him his medications?” his treatment providers wrote in medical records included in his court filings. “He was admitted last week for chest pain and today he was readmitted again for chest pain secondary to non compliance for medications.”

Several weeks later in August, he had a stroke while on a video call with his daughter, according to court filings. “He was struggling to breathe, and was pointing at his chest where he was again experiencing pain, and suddenly stopped speaking.” His daughter screamed for help through the video monitor, according to his petition. “Eventually an officer came in to assist him and cut the feed.”

The man lost his ability to speak for four days, the document says. He was returned to detention, where he remained until a federal judge ordered his release in November.

Impossible Choices

Cassandra Amador waits for the phone to ring every morning, desperate to ask her husband the question that’s woken her up every night for months: “Did you get your medicine?”

Her husband, Pedro Javier Amador Gutierrez, 36, has high blood pressure and depends on the state-run facility in Florida nicknamed “Deportation Depot” to administer the prescriptions that have kept him alive for years. Many mornings, he tells his wife he did not get them.

When she talks to him, she said, he sounds weaker and more scared every day, not like the upbeat man who would take her kids out for ice cream.

“You can hear in his voice how he feels,” she said.

Now, she said, he’s considering returning to Cuba, which he fled because of political persecution, out of fear that he will die in detention without his medicines. Amador and her children would go with him, she said, even though she was born in New Jersey, has never been to Cuba, and doesn’t speak much Spanish.

But he’s already collapsed twice at the Baker Correctional Institution in Sanderson, Florida, his wife said. She’s terrified that the next time, he won’t get up.

Methodology

³Ô¹Ï²»´òìÈ and The Associated Press sifted through thousands of immigration habeas corpus claims to find allegations of medical neglect from people detained by U.S. Immigration and Customs Enforcement during the second Trump administration.

Without a comprehensive, publicly available dataset of medical complaints by those in ICE custody, we used immigration habeas corpus claims to identify detainees’ healthcare-related allegations raised in federal court. Although the intended purpose of habeas corpus is to challenge the legality of a petitioner’s detention — rather than conditions of their confinement — these filings sometimes include detainees’ claims of inadequate healthcare.

But habeas corpus filings are not always publicly available. Federal rules restrict how members of the public can access habeas petitions filed by people in immigration detention. For most of these cases, court websites publish only court orders and dockets describing other filings. The initial petitions are available only through in-person visits to federal courthouses across the country. Habeas Dockets, a project of the nonprofit Immigration Justice Transparency Initiative, coordinates a nationwide network of volunteers to gather these petitions and make them available online.

³Ô¹Ï²»´òìÈ and AP analyzed the dockets of roughly 33,000 cases filed by detainees from Jan. 20, 2025, through March 2026. The vast majority of cases had only basic procedural information, like dates of court filings and rulings. Only about 4,400 included the original petitions.

We also gathered a few dozen case files from courthouses, lawyers, and the Massachusetts federal district court website, which posts most petitions under a unique standing order.

We ran keyword and semantic searches of court records, including petitions, motions, and orders, for terms and phrases potentially related to medical neglect, such as surgery, medications, inadequate medical care, and treatment for chronic conditions such as diabetes and high blood pressure.

We found about 500 cases potentially alleging medical neglect. At least two reporters reviewed each case manually, yielding more than 300 cases containing specific allegations in sworn filings of delayed, denied, or deficient healthcare.

To be conservative, we excluded dozens of cases that alleged inadequate medical care but lacked specifics, for example a petitioner writing, “I have been sick and don’t get proper treatment,” or a judge noting a petitioner “complains that ICE is ignoring his medical problems.” We also excluded cases in which petitioners claimed only that they were denied special diets, exercise, or other accommodations that they said were key to managing their health conditions, such as a petitioner writing, “I suffer from Parkinson’s and cannot properly exercise,” or claiming that the food provided was unfit for a person with diabetes.

The cases we analyzed were neither randomly selected nor representative of immigration habeas filings nationwide. The claims were not independently verified. Many filings are not publicly available, and not all detainees raise medical concerns in court, so our account of cases represents a limited window into the landscape of claims, rather than a comprehensive picture.

Associated Press journalists Garance Burke, Valerie Gonzalez, and Tim Sullivan as well as ³Ô¹Ï²»´òìÈ correspondent Kate Wells contributed to this report.

This report is a collaboration between The Associated Press and ³Ô¹Ï²»´òìÈ.

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .

Lately, however, the community has been trying to stave off a new identity of “prison town” as it fights the opening of what could become the nation’s largest immigration detention center, holding up to 10,000 people.

Walton County, home to this city of about 5,500, voted overwhelmingly for President Donald Trump in 2024. But, as the administration’s mass deportation strategy hits closer to home — with plans moving forward to transform a more than 1 million-square-foot warehouse into a holding pen — locals say the city’s infrastructure just can’t handle such an influx of people.

This month, Social Circle in federal court against U.S. Immigration and Customs Enforcement. The city’s complaint argues that the operation of a detention facility, what it calls a “mega center,” would harm public health, strain the local freshwater and sewage treatment systems, and overburden emergency medical services “due to Social Circle’s modest EMS capacity and DHS’ nebulous plan for emergency transport,” referring to the Department of Homeland Security, which oversees ICE.

“The community is very unified,” City Manager Eric Taylor said. “We want them to go away.”

Social Circle is one of several communities across the country thrust into a charged national debate about the administration’s mass immigrant deportation strategy. On the campaign trail, Trump said migrants were . But local leaders, , advocacy groups, and others in , , , , and claim the administration is doing the same thing by plopping detention centers into communities without the capacity to handle a surge of people.

Last year, Todd Lyons, who is serving as acting director of ICE , described a goal to have the mass deportation operate with the . Deportations would move “like Prime, but with human beings,” he said at a border security expo in Phoenix.

ICE is now putting every person they seek to deport in detention, including those with no criminal records, without the possibility of release on bond. In January, the agency held almost twice as many people as it had that same month in 2024 under President Joe Biden.

However, while many supporters remain aligned with Trump’s immigration stance, some locals fear their city’s stability will be jeopardized. “Social Circle is not exactly flourishing, but it’s making it,” said Gareth Fenley, a retired social worker who ran for state Senate in 2024 as a Democrat and was not among the locals who voted for Trump.

“If Social Circle becomes a prison town,” she said, “we’re gonna lose what we have.”

‘I Thought It Was a Joke’

In February, DHS purchased the 235-acre site in Social Circle for nearly five times its assessed value. It plans to house more people there than at the Rikers Island Correctional Facility in New York City, and nearly triple the number of people now housed at the country’s biggest immigration detention facility, which is in El Paso, Texas.

“I thought it was a joke,” said John Miller, when he first read about the plans last year. He and his wife, Kathlene, have lived in Social Circle for 21 years. When they bump into neighbors, Kathlene knows their children’s names, and John can cite the kids’ baseball stats. Their 50-acre horse farm is less than a mile from the elementary school, and right across the street from the detention center site.

The Millers support Trump’s stance on immigration but feel that turning the vacant warehouse into a detention center would re-create the very problems his administration is trying to solve. Whether people are concentrated in a detention center or out in the public, “they’re still there,” John Miller said.

DHS estimates that the facility would require about 1 million gallons of water daily, according to the city’s suit, which alleges that volume would bleed residents’ taps dry and contaminate local streams with sewage. Emergency medical calls from the detention center, the lawsuit claims, would overwhelm the city’s first responders, which Taylor said clock in at 14 firefighters, 15 police officers, and two school resource officers. The city relies on Walton County for ambulance services.

Additionally, Social Circle would live under an ever-present threat of a major disease outbreak, the lawsuit said, adding that the federal government didn’t conduct the needed environmental reviews or solicit community input beforehand.

Taylor said federal officials had only one meeting with local leaders and brushed off concerns about water, sewage, and emergency care, which administration officials said the site wouldn’t need to use. “I don’t buy that,” Taylor said. “And that’s the problem.”

Supercharging Health Concerns

Current DHS Secretary Markwayne Mullin has said he is reviewing , Kristi Noem, to transform warehouses like this one into detention facilities. And the department’s whether the federal government overpaid for some of the buildings. Mullin also said officials are reviewing agency policies and working with community leaders. “We want to be good partners,” said Lauren Bis, a DHS spokesperson.

Still, the administration’s swift escalation of immigrant detention has exacerbated long-standing allegations of medical neglect for those in custody across the country and led to the in at least two decades.

Three detention facilities in Folkston, Georgia, about an hour north of Jacksonville, Florida, issued 130 emergency calls from Feb. 4, 2025, to Feb. 3, 2026, according to dispatch reports obtained by ³Ô¹Ï²»´òìÈ through a public records request. The calls from the facilities, which hold about 2,000 people, were for wide-ranging reasons, including anaphylaxis, assaults, suicide attempts, overdoses, seizures, strokes, head injuries from falls, and other health issues.

GEO Group, ICE’s largest contractor, which runs the Folkston facility, provides “around-the-clock access to medical care” and relies on emergency medical services as needed, said Christopher Ferreira, director of corporate relations.

ERO El Paso Camp East Montana, built on a Texas military base, is currently the nation’s largest detention center and holds about 2,500 people. In the five months from Aug. 17, 2025, to Jan. 20, 2026, about 130 emergency medical calls were made from the site, according to city records. Several detainees have died at the facility; several others have for tuberculosis, measles, or covid-19.

Amentum Services, which recently took over management of the facility, did not respond to questions about emergency calls.

Even bigger detention facilities, such as the “mega center” planned in Social Circle, would only supercharge those health issues and bring them to new communities, said , who was immigration ombudsman at the Department of Homeland Security under Biden. Existing facilities already suffer from staffing shortages, poor ventilation and hygiene, and insufficient medical care, she said.

The proposed facilities are enormous and generally built for boxes, not people, she said. “There’s no way, without extreme cost, both to the community and just in dollars, to make these safe for humans,” she said.

In the meantime, people such as Kathlene Miller said they feel that Social Circle has become “collateral damage” in the larger debate over immigration. “We’re like the children in a divorce,” she said.

But Social Circle may face an uphill battle. Taylor said Walton County leaders and the state of Georgia have been silent on the center.

“They say it’s federal issues, that they have no jurisdiction,” he said. “They don’t have any interest in helping us.”

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .

North Carolina, in late April, became the latest member of a growing group of Republican-led states to require their public health agencies to flag recipients of Medicaid to the U.S. Department of Homeland Security if their legal status is in question.

It’s a trend health policy researchers expect to spread among GOP-controlled states eager to join Trump in the federal crackdown on Medicaid fraud and illegal immigration. Already, at least four states — , , , and — have passed similar laws, and lawmakers in others, such as and , are weighing measures. In those six states, Republicans hold a power trifecta — both chambers of the legislature and the governor’s office.

“This is an issue that is very much on the political radar right now,” said , a health policy researcher at Harvard Law School.

More than 75 million people , the federal and state-run public health program for people with disabilities and low incomes, or its related Children’s Health Insurance Program, which provides low-cost coverage for people under 19. Immigrants without legal status are ineligible for Medicaid benefits, but a swath of noncitizens qualify, such as green-card holders, asylees, and refugees. A quarter of children in the U.S., most of them citizens, live with an immigrant.

Yet the new reporting laws add a layer of risk for immigrants seeking healthcare in the U.S., where the the use of to help identify and deport people.

Some of the state laws apply only to health agencies, such as in North Carolina. But the bill headed to Tennessee Gov. Bill Lee’s desk , requiring all state agencies to report people suspected of being in the U.S. without legal status. All seven state measures go beyond what’s federally required, which is to cooperate with enforcement officers by providing personal information of recipients when asked.

In Louisiana, families with mixed immigration statuses have reported that the state’s new law, enacted last year, for their kids with U.S. citizenship.

“I expect this law will lead to more families asking whether it is safe to seek healthcare, whether information can be shared with immigration authorities, and whether enrolling a child or seeking treatment could expose them to enforcement consequences,” said , a North Carolina immigration attorney.

North Carolina Republican lawmakers inserted their mandate for the state’s health department as part of a in Medicaid funds, which the legislature cut when it failed to pass a budget last year.

Starting in October, state employees will ask non-U.S. citizens receiving Medicaid for proof of their immigration standing and report those without “satisfactory” legal status to federal authorities. “This bill is designed not only to fund our critical needs today, but to begin looking at fraud, abuse issues we know exist within the system,” Republican state Rep. Donny Lambeth said during a House debate on the bill.

Immigrants than people born in the U.S., according to an analysis by the Cato Institute, a libertarian think tank, which also found noncitizens are much less likely to than citizens. State health agencies are already required to verify whether applicants’ immigration statuses .

Several Republican leaders responsible for the bill did not respond to requests for comment. North Carolina Department of Health and Human Services spokesperson Hannah Jones said the agency is still trying to understand the impact of the new law.

, about half of adults who “likely” lack legal status said someone in their family has avoided seeking medical care because they were concerned their information could draw the attention of immigration enforcement.

, a North Carolina discrimination attorney, said immigrants “in process,” or those waiting for legal authorization, generally already fear using government assistance for themselves.

“What I’ve learned from handling thousands of cases over the years is that most of the individuals who are in process pay for their own medical treatment out-of-pocket,” Rosa said.

Such policies essentially force children who are U.S. citizens to go without health coverage or hospital care, said , a researcher at Georgetown University’s Center for Children and Families.

“When you do policies that target an immigrant, you may think that you are just targeting this one person in the family, but it’s a really imprecise bomb that takes out the whole household,” Cuello said.

The use of states’ public health agencies to find immigrants who lack legal status is not the only strategy states have deployed. Some have passed laws looking to hospitals to collect and report such information. A 2023 Florida law that requires hospital staff to ask about patients’ immigration status has made noncitizens hesitant to seek care, separated families, and caused psychological distress, by the University of South Florida. Texas Gov. Greg Abbott, a Republican, issued an executive order similar to Florida’s law in 2024.

Democratic states have pushed back against Trump administration policies that mine private medical information to target immigrants, with 21 signing on to a filed last year that attempts to prevent DHS from . recipients’ identities could be shared, but medical information could not. Litigation is ongoing.

DHS did not respond to a request for comment on the record.

After he signed the bill into law, North Carolina’s Democratic governor, Josh Stein, urging Republican lawmakers to protect Medicaid coverage for nearly 27,000 pregnant women and children who are lawfully present in the country. He did not respond to questions about the provision that requires the state to report immigrants without legal status.

Polanco-Galdamez said such laws have further eroded trust in healthcare systems among underserved families.

“At the end of the day, public health systems function best when people feel safe seeking medical care,” Polanco-Galdamez said. “Policies that blur the line between healthcare access and immigration enforcement risk pushing vulnerable families further into the shadows.”

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .

The waiver program, run by the Department of Health and Human Services, allows physicians who aren’t U.S. citizens to stay in the country while transitioning from the visa they used during their training to temporary worker status. In exchange, the doctors agree to work in underserved areas for at least three years.

“It will be the patients that suffer the most because in about three months, there’s going to be hundreds of places that are not going to have a physician that should have,” said a psychiatrist caught in the delay.

The doctor — whom ³Ô¹Ï²»´òìÈ agreed not to identify because they fear government reprisal — was among hundreds who applied this year for a J-1 visa waiver through the HHS Exchange Visitor Program.

If they receive one, the psychiatrist — who attended medical school in their home country in Europe before coming to the U.S. for their residency and fellowship — would work with vulnerable and disadvantaged patients in New York.

In recent years, the HHS program reviewed waiver applications in one to three weeks, according to two immigration attorneys.

But it currently has a backlog of hundreds of applications, which still need to be reviewed by the State Department and approved by U.S. Citizenship and Immigration Services, according to four attorneys interviewed by ³Ô¹Ï²»´òìÈ.

They said the foreign physicians will likely have to return to their home countries if their applications don’t advance to USCIS by July 30.

For them to reenter the U.S., their employers would have to pay a new $100,000 fee associated with the H-1B work visa. It’s a cost that many hospitals and clinics in rural and underserved areas say they can’t afford. “That’s the cliff that this train is headed for,” said Charles Wintersteen, a Chicago-based attorney who specializes in health workforce-related immigration.

HHS spokesperson Emily Hilliard didn’t answer questions about the number of pending applications or explain what caused the delays. But she said the Exchange Visitor Program has reviewed all fiscal year 2025 clinical J-1 waiver applications, as well as some from fiscal 2026.

The department is “implementing key process improvements to prevent future delays” and “working diligently” to evaluate remaining applications ahead of the July 30 deadline, she said.

The psychiatrist in limbo said employers hiring J-1 waiver physicians have to show they were unable to fill positions with American workers. If the doctors they planned to hire can’t arrive on time — or at all — patients will have to wait even longer for those vacancies to be filled, they said.

Wintersteen said postgraduate medical education positions are largely funded through Medicare and that “the taxpayers who pay for that training will not get the benefit of it.”

Physicians and immigration attorneys said HHS hasn’t explained the delays or let them know what to expect from their applications.

“Why would HHS want to take a program that is working — a program that places hundreds of U.S. trained international physicians in highly underserved parts of the country every year — and slow-walk it into non-existence,” Jennifer Minear, a Virginia-based health workforce immigration lawyer, said in an email. “How does that serve the public health? It is baffling.”

Waylaid Waivers

The U.S. healthcare system depends on foreign-born professionals to fill its ranks of doctors, nurses, technicians, and other health providers, particularly in chronically understaffed facilities in rural and low-income urban communities.

Nearly a quarter of physicians in the U.S. went to medical school outside the U.S. or Canada, according to .

Once noncitizens complete postgraduate education in the U.S., which typically ends on June 30, they must return to their home country and wait two years before applying for an H-1B work visa. Or, they can seek , which lets them remain in the U.S. on H-1B status in exchange for working for three years in a provider shortage area.

The attorneys said they’re seeing delays only in the Exchange Visitor Program, not in the other federal or state J-1 waiver programs.

The HHS clinical care program received 750 waiver applications last year, Minear and Wintersteen said, and is reserved for doctors working in pediatrics, psychiatry, family and internal medicine, or obstetrics and gynecology.

The program typically needs to forward recommendations to the State Department by mid-March, from John Whyte, CEO of the American Medical Association.

Minear said HHS stopped processing applications in late September or early October before it started forwarding them again a few months ago.

“But the pace is dramatically slower” than usual, she said.

Minear said the State Department usually takes two or three months to review HHS recommendations and must send them to USCIS before July 30 for most of the doctors to stay in the country.

If they don’t make that deadline, Wintersteen said, doctors will have to leave the country unless they obtain another kind of visa, get a J-1 waiver through another program, or extend their current visa by taking board exams or doing additional training.

The psychiatrist, who is supposed to start work on July 1, said they applied for a waiver in order to stay in the U.S with their partner, and because it would let them help the most vulnerable mental health patients. They said their future clients would likely include trafficking survivors, homeless people, and prison or jail inmates. “That’s the population I want to work with,” they said.

Waiver Delay Meets H-1B Dilemma

President Donald Trump issued a that railed against the tech industry’s use of H-1B work visas. The order created the $100,000 fee that applies to workers in all fields — not only tech — living outside the U.S. The payment doesn’t apply to those already in the country.

As of Feb. 15, employers had paid the fee for 85 workers, from USCIS. It’s unclear if any of those payments were for physicians or other medical providers.

The psychiatrist said officials at the hospital that plans to hire them said they can’t afford to pay to bring them back to the U.S. if they must go home.

“A lot of hospitals who hire J-1 waiver physicians are in underserved areas, and so they treat Medicare and Medicaid patients,” they said. “By definition, for the most part, they’re not rich hospitals.”

Barry Walker, an attorney in Tupelo, Mississippi, focused on health workforce-related immigration, said employers have already spent money on recruiters and attorneys like him to help with the waiver process.

Adding the H-1B fee is “just a deal killer, especially for the small, rural hospitals,” he said.

Attorneys said most employers will sponsor physicians in need of an H-1B visa only if they’re in lucrative specialties, such as cardiology or orthopedics, in which they can recover the cost of the fee.

They said healthcare facilities are much less likely to pay the fee to hire foreign nurses, lab technicians, and other healthcare professionals who are more likely than physicians to complete their training outside the U.S.

Employers , but attorneys said they haven’t heard of a hospital or clinic being granted one.

Fighting on Two Fronts

Physicians, hospital leaders, lawmakers, and immigration experts are trying to draw attention to the J-1 waiver delays at HHS while hoping to overturn or limit the new H-1B fee.

The Trump administration hasn’t acted on letters from , , and that requested an exception to the $100,000 fee for physicians or all healthcare workers.

In March, a bipartisan group of lawmakers that would create a healthcare exemption. It has not yet had a hearing.

At least three lawsuits — from the , a , and a that includes a company that recruits foreign nurses and a union that represents medical graduates — are seeking to end the fee entirely.

As for the J-1 waiver delays, the American Medical Association CEO asked the Exchange Visitor Program to use “emergency batch processing” for physicians with contracts to start work this summer.

Efrén Manjarrez, president of the Society of Hospital Medicine, which represents doctors who work in inpatient units, also called for emergency measures.

“Every day this backlog persists is a day that hospitalized patients in these communities face greater risk,” to the program.

Meanwhile, Canadian hospitals have been recruiting foreign physicians completing their training in the U.S, the psychiatrist said. They said one of their friends accepted an offer, withdrawing their HHS waiver application to head north.

The psychiatrist said if they must leave the U.S., they’ll be separated from their partner and out of a job for months as they work to get licensed in their home country.

Even if their employer were able to afford the H-1B fee, they’re not sure they’d want to return.

“This entire process has been so incredibly painful and just soul-crushing,” they said. “I would rather go to a country that would appreciate my motivation to work with patients.”

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .

Two bills moving through the state Senate seek to prevent immigration enforcement officers from isolating patients from their loved ones and interfering with their ability to get legal help. Analyses for both bills cite reporting by ³Ô¹Ï²»´òìÈ that found family members and attorneys have faced extreme difficulty locating and supporting patients hospitalized while in immigration custody.

³Ô¹Ï²»´òìÈ found that some hospitals have facilitated patient isolation through what are known as blackout policies, which can include registering people under pseudonyms, withholding their names from the hospital directory, and preventing staff from contacting patients’ relatives to let them know their location and condition.

A bill by Democratic state Sen. Caroline Menjivar of the San Fernando Valley, , would largely prohibit the use of blackout policies for patients in immigration custody and ensure they retain the right to have their families and others notified of their whereabouts and condition. Blackout policies would be allowed when the health care provider determines the patient is a credible risk to themself or others and the risk is documented in the patient’s medical record. Patients would also be allowed to receive visitors.

It seeks to address reports of Immigration and Customs Enforcement agents guarding patients in their hospital rooms while they undergo medical exams or talk with doctors, interfering with medical decisions, and pushing for patients to be discharged prematurely to detention facilities ill-equipped to provide follow-up care.

“These are actions that have no place in health care, and it is a clear violation of the patients’ rights,” Menjivar said.

Under Menjivar’s proposal, agents would not be allowed into the rooms of patients they bring in for care unless they can show legal authorization to be there. If agents remain in the room, staff would be required to ask them to leave during medical exams and patient care discussions. If agents refuse, health care facility staff would need to document it.

, authored by state Sen. Susan Rubio, a Democrat from the San Gabriel Valley, would require health care providers to inform staff and relevant volunteers to respond when patients want their families to know where they are, and to post a notice at facility entrances with information about visitation and access policies. The law already says patients can agree to have loved ones notified they’re in the hospital, and Rubio’s bill seeks to make sure staff and others know they can do that for patients in immigration custody.

The federal Department of Homeland Security, which oversees immigration enforcement, did not respond to a request for comment.

Both bills were passed by the Senate Health and Judiciary committees along party lines and will be heard next by the Senate Appropriations Committee.

More than 20 immigrant rights advocates and health care workers voiced support for strengthened protections for patients at a hearing last week.

“This state must do everything in its power to protect against these abuses and ensure detainees have the right to contact their loved ones when they are hospitalized and in critical conditions,” said Hector Pereyra, political manager with the Inland Coalition for Immigrant Justice.

However, representatives from the California Hospital Association and California Medical Association told lawmakers last week they had concerns that directing health care workers to document agents’ badge numbers and ask them to leave patients’ rooms could create conflict and pose a safety risk.

“While we understand that this is an important issue, we want to ensure the bill strikes the right balance and does not create conflicting or unclear obligations for hospitals and their staff and clinicians, particularly in real-time interactions with federal officers,” said Vanessa Gonzalez, a vice president of state advocacy for the hospital association.

³Ô¹Ï²»´òìÈ reported that one man, 43-year-old Julio César Peña, was held at a hospital in Victorville for almost two weeks before his attorney and family found out where he was. Peña, who had terminal kidney disease, was shackled to his hospital bed, guarded by immigration agents, and told he wasn’t allowed to disclose his location, according to his wife. He then suffered a seizure that left him intubated and unconscious, but no one notified his family. Peña died Feb. 25, less than two months after he was released to go home.

Advocates for immigrants and health care workers, as well as lawmakers, fear similar incidents are happening around the state.

Menjivar said her bill “seeks to close the gap between existing law and practice by empowering health care provider entities with the tools to uphold the privacy, health, and visitation rights of a patient brought in under immigration custody.”

SB 915 would prohibit hospitals and clinics from allowing immigration officers to make medical decisions for the patient or provide interpretation. Health care facilities would be required to document and verify, “to the extent possible,” the identities of immigration officers; provide patients access to communication tools; and inform patients of their rights. They would also need to complete discharge planning that includes attempts to coordinate with any receiving facility, such as a detention center, to ensure patients receive follow-up care.

The bills come on the heels of legislation passed last year that sought to limit immigration enforcement at health care facilities, including by prohibiting medical establishments from allowing federal agents without a valid search warrant or court order into private areas. However, that bill did not address situations in which patients are already in immigration custody.

“ICE has instilled fear in our hospitals and has kept us from doing our job,” said SatKartar Khalsa, an emergency medicine resident at a safety net hospital in San Francisco who has treated detained patients and testified in support of SB 915. “This has all led to worse care for our patients and has added another layer of fear among health care workers.”

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .