A Vision for Consistent Health Coverage and Care for Immigrant Families

Immigrant families and communities are experiencing unprecedented threats to their health and wellbeing—from indiscriminate enforcement and family separation that traumatizes children and violates families’ most basic rights, to sweeping exclusions from basic supports including health coverage, food assistance, and early childhood education. Protecting immigrant families in this moment requires both responding to immediate harm and dismantling the structural barriers that have long denied them access to essential supports. In health care, these barriers are glaring—immigrant families face restrictive eligibility rules based on immigration status, inadequate language support, limited culturally-responsive services, and pervasive fears that seeking care could jeopardize their immigration status or lead to enforcement actions. This patchwork of exclusions and barriers prevents consistent access to health care for immigrant families—undermining the health and wellbeing of entire communities. 

Immigrant families face eligibility restrictions based not only on income, health status, and age, but also individual immigration status, how long each individual has held that status, and state of residence. While some states impose restrictions above and beyond those required by federal law, others have dedicated their own funding to create state programs that fill federal gaps in access, recognizing how exclusions undermine the health of families. The result is a deeply unequal landscape in which access to affordable coverage and care depends heavily on where a family lives, in addition to their income, health, and immigration status.  

Even when immigrant families can access affordable coverage, practical barriers to health care persist due to inconsistently implemented and underfunded language access supports and administrative hurdles that disproportionately affect families with limited English proficiency. Many immigrant families also struggle to find culturally-responsive care, with nearly three in ten immigrant adults reporting concerns including providers who fail to listen and a lack of interpretation services. 

These barriers have only grown over the last year and a half as a result of a range of federal actions. These include recently proposed federal reinterpretations of the public charge rule — which when expanded in 2019, led hundreds of thousands of families to withdraw from public benefits. At the same time, the 2025 federal budget law (OBBBA) narrows Medicaid and CHIP eligibility for certain categories of lawfully present immigrants and reduces funding for emergency Medicaid—leaving hundreds of thousands more people uninsured in the coming decade—and rollbacks of language access guidance and civil rights enforcement have further weakened protections for patients with limited English proficiency. 

Now more than ever, it is critical that we focus on what families need, and work toward a vision of consistent health care and coverage for immigrant families—and all families. To achieve this vision, policymakers should take the following steps:  

• Guarantee coverage for all. Develop a comprehensive health insurance program that is available to all children and families, regardless of immigration status.  

• End federal exclusions and waiting periods for health coverage. Repeal the 2025 federal budget law immigrant eligibility restrictions and the Personal Responsibility and Work Opportunity Reconciliation Act of 1996’s (PRWORA) five-year bar for Medicaid/CHIP coverage.  

• Ensure health coverage pathways regardless of status. Allow all immigrants to purchase Marketplace coverage regardless of status and codify Deferred Action for Childhood Arrivals (DACA) recipients’ eligibility for Medicaid and Affordable Care Act (ACA) Marketplace coverage. 

• Reverse restrictive federal agency actions. Rescind the 2025 reinterpretations of “federal public benefit” under PRWORA and codify the 2022 DHS public charge rule to reduce chilling effects and provide clarity for immigrant families as well as legal and social service providers.  

• Strengthen language access in health care. Fully enforce existing Title VI obligations in Medicaid, CHIP, and the ACA Marketplace; require and fund greater access to translated applications and qualified interpreters, including through grants to immigrant-serving organizations; hold agencies accountable through compliance plans and public reporting.  

• Simplify coverage enrollment and renewal processes. Ensure plain-language, multilingual applications and renewal notices and simplify and streamline enrollment and renewals so eligible families do not lose coverage due to administrative barriers, confusion, or language access gaps.  

• Protect privacy. Codify the prohibition against using or sharing health and benefit enrollment data for immigration enforcement and strengthen safeguards to rebuild trust in public systems. 

The United States—where one in four children live in immigrant families—cannot achieve health equity without ensuring that all families, regardless of immigration status, can access the care they need. This means eliminating harmful exclusions, extending comprehensive coverage to all income-eligible people, and building a health care system grounded in linguistically-accessible, culturally-responsive care. Immigrant families are an integral part of our society and deserve a health care system that recognizes their contributions and their humanity. Such a system benefits everyone, promoting health and wellbeing for families and strengthening communities.