Nation, World + Society

Most states’ policies put the health of undocumented immigrants — and their families — at risk

Ohio rules create the greatest health risk for undocumented residents; California the least

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State policies and undocumented
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The study found that some states, but not all, offer child health insurance or similar benefits regardless of immigration status.

California scored the highest in a new ranking of U.S. states’ public policies and laws that support the health and well-being of undocumented immigrants. The report, by the UCLA Center for Health Policy Research and the UCLA Blum Center on Poverty and Health in Latin America, with support from the UC Global Health Institute, also found that Ohio had policies that were more exclusionary than those of any other state.

The report focuses on state policies as of 2014 in nine categories across five areas: public health and welfare, higher education, labor and employment, access to driver licensing and government ID card programs, and enforcement of the federal Secure Communities program — all of which influence the health of immigrants and their families.

The researchers rated each state’s policies as “inclusive” (supporting health and well-being) or “exclusive” (harming health and well-being). Scores, which ranged from +1 to -1 for each category, were then tallied for an overall rating for each state. The average total score was -2.5 points.

California scored a total of +9; liberal-leaning New York scored +­1. Only six other states and Washington, D.C., had overall scores greater than 0. Other surprises: Texas, frequently in the news for its conservative policies, scored +2 overall, making it one of the five most inclusive states. And Florida, which has a large population of recent immigrants, earned a -3. In all, 41 states were in negative territory. 

► See the results in a sortable, state-by-state list.

States with the top five and bottom six overall scores:

Top 5

1. California +9
2. Illinois +7
3. Washington +4
4. (tie) Colorado +2
4. (tie) Texas  +2


Bottom 6

51. Ohio -7
50. (tie) Alabama -6
50. (tie) Arizona -6
50. (tie) Indiana -6
50. (tie) Mississippi -6
50. (tie) West Virginia -6


​“It is frustrating that so many states have policies that ignore or exclude a group of people who work hard and contribute so much to our society,” said Steven Wallace, associate director of the Center for Health Policy Research and co-author of the report. “The neglect or outright discrimination of the undocumented does not just hurt workers and their families; it hurts the communities that rely on them for the basic labor that makes our society function.”

Policies affect millions

The states’ public policies — and how each responds to flexibility in federal laws — affect the estimated 11.2 million undocumented immigrants living in the country, according to the report. The policies evaluated in the study also affect about 4 million U.S.-born children who live in “mixed-status” families, in which at least one parent is undocumented.

Laws in Arizona — including its immigration status check provision — and in other states have attracted federal court challenges and much media attention. Yet many state laws that can either promote or complicate the health of undocumented immigrants receive little attention.

Examples of beneficial or harmful policy outcomes, by program area:

Public health and welfare. Some states offer child health insurance or similar benefits regardless of immigration status, and some offer full Medicaid to pregnant undocumented women, but many do not. Most states determine eligibility for food stamps (now known as Supplemental Nutrition Assistance Program, or SNAP) by factoring in the family’s income and the number of all family members, regardless of their immigration status. But five states, including Arizona and Ohio, calculate eligibility for assistance using the income of all family members, but determine “family size” based only on those who are citizens or lawful permanent residents. This makes it more difficult for families with undocumented members to qualify.

Higher education. Twenty states, including California, Illinois, Florida, New York and Texas, allow undocumented students who attended secondary school in the state to pay in-state tuition for colleges and universities. Five of those, including California and Texas, also offer scholarship funding for those students. The rest require undocumented college students to pay out-of-state tuition, even if they attended K-12 in-state. Among the most exclusive is Georgia, which bars undocumented students from attending many of its public colleges and universities — even if they graduated from high schools in the state.

Labor and employment. Ten states’ worker compensation laws classify undocumented workers as “employees,” which qualifies them for workers’ compensation if they are injured on the job. But many states encourage public and private employers making hiring decisions to use the federal employment tool, E-verify, to check if an immigrant is authorized to work. Twenty states require state agencies, state contractors and/or private employers to use E-Verify; only two — California and Illinois — limit its use.

Access to driver’s licenses and government IDs. While some undocumented people can obtain identifications cards from their consular offices, cities such as Chicago, Oakland and San Francisco offer municipal IDs, which allow more access to public and private services. As of 2014, six states — California, Colorado, Illinois, Oregon, Utah and Washington — have laws that provide driver’s licenses to undocumented residents. But a federal law, REAL ID, puts restrictions on states that grant driver’s licenses or other IDs to the undocumented. Half of the states have passed resolutions or statute opposing the law.

Secure Communities. This enforcement program required that local police share information with federal immigration authorities, and it has contributed to the deportation of roughly 400,000 people per year, according to Pew Research. This has separated families and put stress on immigrants’ finances and health, the authors write. California, Connecticut and Colorado have adopted policies that prevent some undocumented immigrants charged with low-level, nonviolent offenses from being turned over to federal immigration authorities. Secure Communities was replaced by the Priority Enforcement Program, which does not require local law enforcement agencies to share information gathered in an arrest with the federal government.

Even high-scoring states can improve

Even the states that earned positive scores have room for improvement. The authors recommend actions all states can take to create a better environment for undocumented immigrants:

  • Strengthen laws that secure undocumented immigrants’ rights in the five areas reviewed in the report.
  • Buffer federal laws that restrict undocumented immigrants’ rights or access to resources.
  • Focus on passing laws that are inclusive, rather than laws that explicitly exclude residents based on their legal status.
  • More closely examine public policies for their ultimate impact on undocumented immigrants’ health.

“State and national lawmakers must recognize the value undocumented immigrants have in our country,” said Dr. Michael Rodriguez, co-author of the report, of the Blum Center and a faculty associate at the Center for Health Policy Research. “States must understand the critical role their policies play in promoting or hindering the well-being of undocumented immigrants who are an important part of the economic, political and social fabric of our nation.” 

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