A week earlier, immigration agents had grabbed Julio César Peña from his front yard in Glendale, California. Now, he was in a hospital after suffering a ministroke. He was shackled to the bed by his hand and foot, he told Romero, and agents were in the room, listening to the call. He was scared he would die and wanted his wife there.

“What hospital are you at?” Romero asked.

“I can’t tell you,” he replied.

Viridiana Chabolla, Peña’s attorney, couldn’t get an answer to that question, either. Peña’s deportation officer and the medical contractor at the Adelanto ICE Processing Center refused to tell her. Exasperated, she tried calling a nearby hospital, Providence St. Mary Medical Center.

“They said even if they had a person in ICE custody under their care, they wouldn’t be able to confirm whether he’s there or not, that only ICE can give me the information,” Chabolla said. The hospital confirmed this policy to KFF Health News.

Family members and attorneys for patients hospitalized after being detained by federal immigration officials said they are facing extreme difficulty trying to locate patients, get information about their well-being, and provide them emotional and legal support. They say many hospitals refuse to provide information or allow contact with these patients. Instead, hospitals allow immigration officers to call the shots on how much — if any — contact is allowed, which can deprive patients of their constitutional right to seek legal advice and leave them vulnerable to abuse, attorneys said.

Hospitals say they are trying to protect the safety and privacy of patients, staff, and law enforcement officials, even while hospital employees in Los Angeles, Minneapolis, and Portland, Ore., cities where Immigration and Customs Enforcement has conducted immigration raids, say it’s made their jobs difficult. Hospitals have used what are sometimes called blackout procedures, which can include registering a patient under a pseudonym, removing their name from the hospital directory, or prohibiting staff from even confirming that a patient is in the hospital.

“We’ve heard incidences of this blackout process being used at multiple hospitals across the state, and it’s very concerning,” said Shiu-Ming Cheer, the deputy director of immigrant and racial justice at the California Immigrant Policy Center, an advocacy group.

Some Democratic-led states, including California, Colorado, and Maryland, have enacted legislation that seeks to protect patients from immigration enforcement in hospitals. However, those policies do not address protections for people already in ICE custody.

More Detainees Hospitalized

Peña is among more than 350,000 people arrested by federal immigration authorities since President Donald Trump returned to the White House. As arrests and detentions have climbed, so too have reports of people taken to hospitals by immigration agents because of illness or injury — due to preexisting conditions or problems stemming from their arrest or detention.

ICE has faced criticism for using aggressive and deadly tactics, as well as for reports of mistreatment and inadequate medical care at its facilities. Sen. Adam Schiff (D-Calif.) told reporters at a Jan. 20 news conference outside a detention center he visited in California City that he spoke to a diabetic woman held there who had not received treatment in two months.

While there are no publicly available statistics on the number of people sick or injured in ICE detention, the agency’s news releases point to 32 people who died in immigration custody in 2025. Six more have died this year.

The Department of Homeland Security, which oversees ICE, did not respond to a request for information about its policies or Peña’s case.

According to ICE’s guidelines, people in custody should be given access to a telephone, visits from family and friends, and private consultation with legal counsel. The agency can make administrative decisions, including about visitation, when a patient is in the hospital, but should defer to hospital policies on contacting next of kin when a patient is seriously ill, the guidelines state.

Asked in detail about hospital practices related to patients in immigration custody and whether there are best practices that hospitals should follow, Ben Teicher, a spokesperson for the American Hospital Association, declined to comment.

David Simon, a spokesperson for the California Hospital Association, said that “there are times when hospitals will — at the request of law enforcement — maintain confidentiality of patients’ names and other identifying characteristics.”

Although policies vary, members of the public can typically call a hospital and ask for a patient by name to find out whether they’re there, and often be transferred to the patient’s room, said William Weber, an emergency physician in Minneapolis and medical director for the Medical Justice Alliance, which advocates for the medical needs of people in law enforcement custody. Family members and others authorized by the patient can visit. And medical staff routinely call relatives to let them know a loved one is in the hospital, or to ask for information that could help with their care.

But when a patient is in law enforcement custody, hospitals frequently agree to restrict this kind of information sharing and access, Weber said. The rationale is that these measures prevent unauthorized outsiders from threatening the patient or law enforcement personnel, given that hospitals lack the security infrastructure of a prison or detention center. High-profile patients such as celebrities sometimes also request this type of protection.

Several attorneys and health care providers questioned the need for such restrictions. Immigration detention is civil, not criminal, detention. The Trump administration says it’s focused on arresting and deporting criminals, yet most of those arrested have no criminal conviction, according to data compiled by the Transactional Records Access Clearinghouse and several news outlets.

Taken Outside His Home

According to Peña’s wife, Romero, he has no criminal record. Peña came to the United States from Mexico in sixth grade and has an adult son in the U.S. military. The 43-year-old has terminal kidney disease and survived a heart attack in November. He has trouble walking and is partially blind, his wife said. He was detained Dec. 8 while resting outside after coming home from dialysis treatment.

Initially, Romero was able to find her husband through the ICE Online Detainee Locator System. She visited him at a temporary holding facility in downtown Los Angeles, bringing him his medicines and a sweater. She then saw he’d been moved to the Adelanto detention center. But the locator did not show where he was after he was hospitalized.

When she and other relatives drove to the detention facility to find him, they were turned away, she said. Romero received occasional calls from her husband in the hospital but said they were less than 10 minutes long and took place under ICE surveillance. She wanted to know where he was so she could be at the hospital to hold his hand, make sure he was well cared for, and encourage him to stay strong, she said.

Shackling him and preventing him from seeing his family was unfair and unnecessary, she said.

“He’s weak,” Romero said. “It’s not like he’s going to run away.”

ICE guidelines say contact and visits from family and friends should be allowed “within security and operational constraints.” Detainees have a constitutional right to speak confidentially with an attorney. Weber said immigration authorities should tell attorneys where their clients are and allow them to talk in person or use an unmonitored phone line.

One of his clients was Bayron Rovidio Marin, a car wash worker injured during a raid in August. Immigration agents surveilled him for over a month at Harbor-UCLA Medical Center, a county-run facility, without charging him.

In November, the Los Angeles County Board of Supervisors voted to curb the use of blackout policies for patients under civil immigration custody at county-run hospitals. In a statement, Arun Patel, the chief patient safety and clinical risk management officer for the Los Angeles County Department of Health Services, said the policies are designed to reduce safety risks for patients, doctors, nurses, and custody officers.

“In some situations, there may be concerns about threats to the patient, attempts to interfere with medical care, unauthorized visitors, or the introduction of contraband,” Patel said. “Our goal is not to restrict care but to allow care to happen safely and without disruption.”

Leaving Patients Vulnerable

Thompson-Lleras said he’s concerned that hospitals are cooperating with federal immigration authorities at the expense of patients and their families and leaving patients vulnerable to abuse.

“It allows people to be treated suboptimally,” Thompson-Lleras said. “It allows people to be treated on abbreviated timelines, without supervision, without family intervention or advocacy. These people are alone, disoriented, being interrogated, at least in Bayron’s case, under pain and influence of medication.”

Such incidents are alarming to hospital workers. In Los Angeles, two health care professionals who asked not to be identified by KFF Health News, out of concern for their livelihoods, said that ICE and hospital administrators, at public and private hospitals, frequently block staff from contacting family members for people in custody, even to find out about their health conditions or what medications they’re on. That violates medical ethics, they said.

Blackout procedures are another concern.

“They help facilitate, whether intentionally or not, the disappearance of patients,” said one worker, a physician for the county’s Department of Health Services and part of a coalition of concerned health workers from across the region.

At Legacy Emanuel Medical Center in Portland, nurses publicly expressed outrage over what they saw as hospital cooperation with ICE and the flouting of patient rights. Legacy Health has sent a cease and desist letter to the nurses’ union, accusing it of making “false or misleading statements.”

“I was really disgusted,” said Blaire Glennon, a nurse who quit her job at the hospital in December. She said numerous patients were brought to the hospital by ICE with serious injuries they sustained while being detained. “I felt like Legacy was doing massive human rights violations.”

Handcuffed While Unconscious

Two days before Christmas, Chabolla, Peña’s attorney, received a call from ICE with the answer she and Romero had been waiting for. Peña was at Victor Valley Global Medical Center, about 10 miles from Adelanto, and about to be released.

Excited, Romero and her family made the two-hour-plus drive from Glendale to the hospital to take him home.

When they got there, they found Peña intubated and unconscious, his arm and leg still handcuffed to the hospital bed. He’d had a severe seizure on Dec. 20, but no one had told his family or legal team, his attorney said.

Tim Lineberger, a spokesperson for Victor Valley Global Medical Center’s parent company, KPC Health, said he could not comment on specific patient cases, because of privacy protections. He said the hospital’s policies on patient information disclosure comply with state and federal law.

Peña was finally cleared to go home on Jan. 5. No court date has been set, and his family is filing a petition to adjust his legal status based on his son’s military service. For now, he still faces deportation proceedings.

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Una semana antes, agentes de inmigración apresaron a Julio César Peña delante de su casa en Glendale, California, y se lo llevaron. Ahora estaba en un hospital, después de haber sufrido un mini derrame cerebral. Le dijo a Romero que lo tenían esposado a la cama, de una mano y un pie, y que había agentes en la habitación escuchando la llamada. Tenía miedo de morir y quería que su esposa estuviera con él.

“¿En qué hospital estás?”, le preguntó Romero.

“No te puedo decir”, respondió él.

Viridiana Chabolla, abogada de Peña, tampoco pudo obtener una respuesta. El oficial de deportación asignado al caso y la empresa médica contratada en el Centro de Procesamiento del ICE en Adelanto se negaron a decirle dónde estaba internado. Frustrada, intentó llamar a un hospital cercano, el Providence St. Mary Medical Center.

“Me dijeron que aunque tuvieran bajo su cuidado a una persona detenida por el ICE, no podrían confirmar si estaba allí o no, que solo el ICE puede darme esa información”, contó Chabolla. El hospital confirmó esa política a KFF Health News.

Familiares y abogados de personas internadas tras ser detenidas por autoridades federales de inmigración dijeron que enfrentan grandes obstáculos para localizar a los pacientes, saber cómo están de salud y brindarles apoyo legal y emocional.

Aseguran que muchos hospitales se niegan a dar información o permitir el contacto con las personas detenidas. En cambio, dejan que los agentes de inmigración decidan cuánto contacto se permite, si es que se permite alguno. Esto, según los abogados, les arrebata a los pacientes su derecho constitucional a recibir asesoría legal, y los deja vulnerables a abusos.

Los hospitales dicen que buscan proteger la seguridad y privacidad de los pacientes, el personal y las autoridades, aunque empleados de centros de salud en Los Ángeles, Minneapolis y Portland, Oregon —ciudades donde el ICE ha realizado redadas— afirman que eso les ha dificultado su trabajo.

Algunos hospitales aplican lo que llaman “procedimientos de apagón” o blackout —a veces llamado “código negro”— que pueden incluir registrar al paciente con un seudónimo, eliminar su nombre del directorio del hospital o prohibir al personal confirmar si la persona está hospitalizada.

“Sabemos de varios casos en los que se usó este procedimiento de apagón en hospitales del estado, y es muy preocupante”, dijo Shiu-Ming Cheer, subdirectora de justicia migratoria y racial en el California Immigrant Policy Center, una organización de defensa de los inmigrantes.

Estados gobernados por demócratas, como California, Colorado y Maryland, han aprobado leyes para proteger a pacientes de operativos de inmigración dentro de hospitales. Sin embargo, esas leyes no cubren a quienes ya están bajo custodia del ICE.

Más detenidos hospitalizados

Peña es una de las más de 350.000 personas arrestadas por autoridades migratorias desde que el presidente Donald Trump regresó a la Casa Blanca.

A medida que aumentan los arrestos y detenciones, también lo hacen los reportes de personas trasladadas a hospitales por agentes de inmigración debido a enfermedades o lesiones, ya sea por condiciones preexistentes o derivadas del arresto o la detención.

El ICE ha recibido críticas por utilizar tácticas agresivas y mortales, y por reportes de maltrato y atención médica deficiente en sus centros de detención. El senador Adam Schiff, demócrata de California, dijo el 20 de enero, en una conferencia de prensa, frente a un centro de detención en California City, que habló con una mujer con diabetes detenida allí que no había recibido tratamiento en dos meses.

No hay estadísticas públicas sobre cuántas personas enferman o se lesionan bajo custodia del ICE, pero comunicados de prensa de la agencia indican que 32 personas murieron bajo custodia migratoria en 2025.

En lo que va del año, han muerto seis más.

El Departamento de Seguridad Nacional, que supervisa al ICE, no respondió a solicitudes de información sobre sus políticas ni sobre el caso de Peña.

Según las propias directrices del ICE, las personas bajo su custodia deben tener acceso a un teléfono, visitas de familiares y amigos, y consultas privadas con sus abogados.

La agencia puede tomar decisiones administrativas, incluyendo el tema de las visitas,  cuando un detenido está hospitalizado; pero, según las directrices, debe respetar las políticas del hospital para contactar a familiares si la persona está gravemente enferma.

Consultado sobre las prácticas hospitalarias con personas bajo custodia migratoria, y sobre si existen protocolos recomendados, Ben Teicher, vocero de la Asociación Estadounidense de Hospitales, no quiso comentar.

David Simon, vocero de la Asociación de Hospitales de California, expresó que “en algunos casos, a pedido de las autoridades, los hospitales mantienen la confidencialidad de los nombres de los pacientes y otra información que los identifique”.

Aunque las políticas varían, por lo general cualquier persona puede llamar a un hospital y preguntar por un paciente dando su nombre, y con frecuencia se le transfiere la llamada a la habitación, dijo William Weber, médico de emergencias en Minneapolis y director médico de Medical Justice Alliance, una organización que defiende los derechos médicos de personas bajo custodia.

Los familiares y personas autorizadas por el paciente pueden visitarlo. El personal médico también suele llamar a los familiares para informarles que alguien está hospitalizado o para pedir información que ayude en su atención.

Pero cuando se trata de personas bajo custodia de autoridades, los hospitales frecuentemente acceden a restringir el acceso y dar información, señaló Weber.

El argumento es que estas medidas evitan que personas no autorizadas amenacen al paciente o al personal, ya que los hospitales no tienen la infraestructura de seguridad de una cárcel. Algunos pacientes famosos también solicitan este tipo de medidas.

Abogados y trabajadores de salud cuestionan que esas restricciones sean realmente necesarias. La detención migratoria es una detención civil, no criminal. Aunque el gobierno de Trump afirma que su prioridad es arrestar y deportar criminales, la mayoría de los detenidos no tiene antecedentes penales, según datos del centro Transactional Records Access Clearinghouse y varios medios de comunicación.

Detenido delante de su casa

Según su esposa, Peña no tiene antecedentes penales. Llegó a Estados Unidos desde México cuando cursaba sexto grado, y tiene un hijo adulto en el ejército estadounidense. Tiene 43 años, padece enfermedad renal terminal y sobrevivió a un infarto en noviembre. Camina con dificultad y tiene pérdida parcial de la vista, explicó Romero. Fue detenido el 8 de diciembre, mientras descansaba en el exterior de su casa tras un tratamiento de diálisis.

Al principio, Romero logró ubicar a su esposo con el sistema en línea para localizar detenidos del ICE. Lo visitó en un lugar de detención temporal en el centro de Los Ángeles, donde le llevó sus medicinas y un suéter. Luego vio que lo trasladaron al centro de detención en Adelanto. Pero después de que fue hospitalizado, ya no apareció en la base de datos.

Cuando ella y otros familiares fueron al centro de detención para preguntar por él, les negaron el acceso. Romero recibía llamadas ocasionales de su esposo desde el hospital, pero duraban menos de 10 minutos y estaban monitoreadas por el ICE. Ella quería saber en qué hospital estaba para poder estar con él, tomarle la mano, asegurarse de que lo atendieran bien y darle ánimos.

Dijo que mantenerlo esposado y sin ver a su familia era injusto e innecesario.“Está débil”, dijo Romero. “No existe riesgo de que pueda escaparse”.

Las directrices del ICE indican que debe permitirse el contacto y las visitas de familiares “dentro de las limitaciones de seguridad y operativas”. Las personas detenidas tienen derecho constitucional a hablar en privado con su abogado. Weber explicó que las autoridades migratorias deben informar a los abogados dónde están sus clientes y permitirles hablar con ellos en persona o mediante una línea telefónica sin vigilancia.

Sin embargo, los hospitales están en una zona gris respecto a cómo hacer cumplir estos derechos, ya que su enfoque principal es la atención médica, dijo Weber. Aun así, agregó, deben asegurarse de que sus políticas estén alineadas con la ley.

Familia sin acceso

Varios abogados de inmigración han pasado semanas intentando localizar a clientes detenidos por el ICE, y en ocasiones sus esfuerzos han sido frustrados por los hospitales.

Nicolas Thompson-Lleras, abogado de Los Ángeles  que representa a personas en proceso de deportación, contó que, el año pasado, dos de sus clientes fueron registrados con nombres falsos en distintos hospitales del condado de Los Ángeles. Inicialmente, los hospitales negaron que los pacientes estuvieran ahí y no permitieron que el abogado los viera. También se les negó el acceso a los familiares.

Uno de esos clientes fue Bayron Rovidio Marín, trabajador de un negocio de lavado de autos, que resultó herido durante una redada en agosto. Agentes migratorios lo vigilaron por más de un mes en el hospital Harbor-UCLA, un centro público, sin presentar cargos.

En noviembre, la Junta de Supervisores del condado de Los Ángeles votó a favor de limitar el uso de políticas de apagón en hospitales públicos para pacientes bajo custodia civil de inmigración. En un comunicado, Arun Patel, director de seguridad del paciente y gestión de riesgos clínicos del Departamento de Servicios de Salud del condado, dijo que estas políticas buscan reducir riesgos para pacientes, médicos, enfermeros y agentes.

“En algunos casos, puede haber preocupaciones sobre amenazas al paciente, intentos de interferir con la atención médica, visitantes no autorizados o el ingreso de objetos prohibidos”, dijo Patel. “Nuestro objetivo no es restringir la atención, sino permitir que se brinde de forma segura y sin interrupciones”.

Pacientes más vulnerables

Thompson-Lleras expresó preocupación de que los hospitales estén colaborando con autoridades migratorias a costa de los pacientes y sus familias, lo que los deja vulnerables a abusos.

“Permite que las personas reciban atención deficiente”, dijo. “Permite que los traten de forma acelerada, sin supervisión, sin intervención familiar y sin defensa alguna. Estas personas están solas, desorientadas, siendo interrogadas —al menos en el caso de Bayron— bajo dolor y efectos de medicamentos”.

Estas situaciones también alarman al personal de salud. En Los Ángeles, dos trabajadores de hospitales —que pidieron no ser identificados por temor a sufrir represalias— dijeron a KFF Health News que el ICE y administradores de hospitales públicos y privados bloquean con frecuencia el contacto entre el personal médico y los familiares de personas detenidas, incluso para obtener información médica necesaria. Eso, afirmaron, va contra la ética médica.

Los procedimientos de apagón son otra preocupación.

“Facilitan, aunque no sea intencionalmente, la desaparición de pacientes”, dijo una de las personas, médica en el Departamento de Servicios de Salud del condado y parte de una coalición de trabajadores preocupados en la región.

En el Legacy Emanuel Medical Center, en Portland, enfermeras expresaron públicamente su indignación por lo que vieron como cooperación con el ICE y violaciones de los derechos de los pacientes. La red Legacy Health envió una carta al sindicato de enfermeras para que frenara esto, acusándolo de hacer declaraciones falsas o engañosas.

“Me dio asco”, dijo Blaire Glennon, una enfermera que renunció en diciembre. Afirmó que muchos pacientes fueron llevados por el ICE al hospital con lesiones graves sufridas durante la detención. “Sentí que Legacy estaba cometiendo enormes violaciones a los derechos humanos”.

Esposado estando inconsciente

Dos días antes de Navidad, Chabolla, la abogada de Peña, recibió una llamada de ICE con la información que ella y Romero llevaban semanas esperando. Peña estaba en el hospital Victor Valley Global Medical Center, a unas 10 millas de Adelanto, y estaba a punto de ser dado de alta.

Emocionados, Romero y su familia manejaron más de dos horas desde Glendale hasta el hospital para recogerlo.

Pero al llegar, encontraron a Peña intubado e inconsciente, todavía esposado de un brazo y una pierna a la cama. Había tenido una fuerte convulsión el 20 de diciembre, pero nadie informó a su familia ni a su abogada, dijo Chabolla.

Tim Lineberger, vocero del grupo KPC Health —propietario del hospital—, dijo que no podía comentar sobre casos específicos por razones de privacidad. Afirmó que las políticas del hospital sobre divulgación de información cumplen con las leyes estatales y federales.

Peña fue dado de alta finalmente el 5 de enero. Aún no tiene fecha de audiencia y su familia presentó una petición para modificar su estatus migratorio en función del servicio militar de su hijo. Por ahora, sigue en proceso de deportación.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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For several years, that number has been zero in the predominantly white, largely rural county stretching from Sacramento’s eastern suburbs to the shores of Lake Tahoe.

The trend could be short-lived.

County health officials there and across the country are bracing for an estimated 10 million newly uninsured patients over the next decade in the wake of Republicans’ One Big Beautiful Bill Act. The act, which President Donald Trump signed into law this past summer, is also expected to reduce Medicaid spending by more than $900 billion over that period.

“This is the moment where a lot of hard decisions have to be made about who gets care and who doesn’t,” said Nadereh Pourat, director of the Health Economics and Evaluation Research Program at UCLA. “The number of people who are going to lose coverage is large, and a lot of the systems that were in place to provide care to those individuals have either gone away or diminished.”

It’s an especially thorny challenge for states like California and New Mexico where counties are legally required to help their poorest residents through what are known as indigent care programs. Under Obamacare, both states were able to expand Medicaid to include more low-income residents, alleviating counties of patient loads and redirecting much of their funding for the patchwork of local programs that provided bare-bones services.

Placer County, which estimates that 16,000 residents could lose health care coverage by 2028, quit operating its own clinics nearly a decade ago.

“Most of the infrastructure that we had to meet those needs is gone,” said Rob Oldham, Placer County’s director of health and human services. “This is a much bigger problem than it was a decade ago and much more costly.”

In December, county officials asked to join a statewide association that provides care to mostly small, rural counties, citing an expected rise in the number of uninsured residents.

New Mexico’s second-most-populous county, Doña Ana, added dental care for seniors and behavioral health benefits after many of its poorest residents qualified for Medicaid. Now, federal cuts could force the county to reconsider, said Jamie Michael, Doña Ana’s health and human services director.

“At some point we’re going to have to look at either allocating more money or reducing the benefits,” Michael said.

Straining State Budgets

Some states, such as Idaho and Colorado, abandoned laws that required counties to be providers of last resort for their residents. In other states, uninsured patients often delay care or receive it at hospital emergency rooms or community clinics. Those clinics are often supported by a mix of federal, state, and local funds, according to the National Association of Community Health Centers.

Even in states like Texas, which opted not to expand its Medicaid program and continued to rely on counties to care for many of its uninsured, rising health care costs are straining local budgets.

“As we have more growth, more people coming in, it’s harder and harder to fund things that are required by the state legislature, and this isn’t one we can decrease,” said Windy Johnson, program manager with the Texas Indigent Health Care Association. “It is a fiscal issue.”

California lawmakers face a nearly $18 billion budget deficit in the 2026-27 fiscal year, according to the latest estimates by the state’s nonpartisan Legislative Analyst’s Office. Gov. Gavin Newsom, who has acknowledged he is mulling a White House run, has rebuffed several efforts to significantly raise taxes on the ultra-wealthy. Despite blasting the bill passed by Republicans in Congress as a “complete moral failure” that guts health care programs, in 2025 the Democrat rolled back state Medi-Cal benefits for seniors and for immigrants without legal status after rising costs forced the program to borrow $4.4 billion from the state’s general fund.

H.D. Palmer, a spokesperson for the state’s Department of Finance, said that the Newsom administration is still refining its fiscal projections and that it would be “premature” to discuss potential budget solutions.

Newsom will unveil his initial budget proposal in January. State officials have said California could lose $30 billion a year in federal funding for Medi-Cal under the new law, as much as 15% of the state program’s entire budget.

“Local governments don’t really have much capacity to raise revenue,” said Scott Graves, a director at the independent California Budget & Policy Center with a focus on state budgets. “State leaders, if they choose to prioritize it, need to decide where they’re going to find the funding that would be needed to help those who are going to lose health care as a result of these federal funding and policy cuts.”

Reviving county-based programs in the near term would require “considerable fiscal restructuring” through the state budget, the Legislative Analyst’s Office said in an October report.

No Easy Fixes

It’s not clear how many people are currently enrolled in California’s county indigent programs, because the state doesn’t track enrollment and utilization. But enrollment in county health safety net programs dropped dramatically in the first full year of ACA implementation, going from about 858,000 people statewide in 2013 to roughly 176,000 by the end of 2014, according to a survey at the time by Health Access California.

“We’re going to need state investment,” said Michelle Gibbons, executive director of the County Health Executives Association of California. “After the Affordable Care Act and as folks got coverage, we didn’t imagine a moment like this where potentially that progress would be unwound and folks would be falling back into indigent care.”

In November, voters in affluent Santa Clara County approved a sales tax increase, in part to backfill the loss of federal funds. But even in the home of Silicon Valley, where the median household income is about 1.7 times the statewide average, that is expected to cover only a third of the $1 billion a year the county stands to lose.

Health advocates fear that, absent major state investments, Californians could see a return to the previous patchwork of county-run programs, with local governments choosing whom and what they cover and for how long.

In many cases, indigent programs didn’t include specialty care, behavioral health, or regular access to primary care. Counties can also exclude people based on immigration status or income. Before the ACA, many uninsured people who needed care didn’t get it, which could lead to them winding up in ERs with untreated health conditions or even dying, said Kiran Savage-Sangwan, executive director of the California Pan-Ethnic Health Network.

Rachel Linn Gish, interim deputy director of Health Access California, a consumer advocacy group, said that “it created a very unequal, maldistributed program throughout the state.”

“Many of us,” she said. “including counties, are reeling trying to figure out: What are those downstream impacts?”

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Tomaron comida enlatada, frutas y verduras, y una tarjeta de regalo para el supermercado. Luego, Basu vio una fila de mesas en el estacionamiento, atendidas por trabajadores del área de servicios sociales, que ayudaban a la gente a solicitar asistencia alimentaria y cobertura de salud. Le dijeron que su suegra, quien también recibe Medicaid, podría calificar para recibir ayuda alimentaria.

“Tendría que separar menos dinero”, dijo Basu, que es la única que aporta ingresos en su hogar en Anaheim desde que su esposo sufrió un derrame cerebral. “Tal vez pueda usar ese dinero extra para cubrir otros gastos”.

Basu fue una de las más de 3.000 personas que asistieron a un evento de CalOptima en noviembre, en uno de los condados más ricos de California. La jornada marcó el inicio de una campaña de $20 millones por parte de esta aseguradora de Medicaid. El objetivo es ayudar a que residentes de bajos ingresos accedan y conserven su cobertura médica y sus beneficios de alimentos, en el momento en que comiencen a aplicarse las restricciones federales establecidas en la ley de presupuesto impulsada por el presidente Donald Trump, llamada Una Gran y Hermosa Ley (One Big Beautiful Bill Act).

La ley recorta más de $900.000 millones en financiamiento federal para Medicaid, conocido como Medi-Cal en California. También elimina alrededor de $187.000 millones del Programa de Asistencia Nutricional Suplementaria (SNAP, por sus siglas en inglés), conocido como CalFresh en California. Esto representa cerca del 20% del presupuesto del programa en los próximos 10 años. Como resultado, hasta 3,4 millones de beneficiarios de Medi-Cal y casi 400.000 personas que usan CalFresh podrían perder estos beneficios. (La mayoría de quienes reciben CalFresh también tienen Medi-Cal).

Representantes republicanos dicen que estos cambios —algunos de los cuales ya están en vigor— ayudarán a prevenir el fraude y el despilfarro mediante controles de elegibilidad más estrictos y nuevos requisitos laborales.

Sin embargo, los planes de salud de Medicaid en todo el país están reforzando sus actividades comunitarias para no perder afiliados, muchos de los cuales ya enfrentan altos costos de alimentos y atención médica.

En el condado de Los Ángeles, el plan de salud L.A. Care lanzó en diciembre reuniones comunitarias para informar a la población sobre los cambios en Medi-Cal. En Hawaii, AlohaCare está reactivando una alianza creada durante la pandemia de covid para mitigar el impacto de la pérdida de cobertura. Y en Philadelphia, Community Behavioral Health, un plan de Medicaid para la salud mental, tiene previsto organizar una serie de encuentros durante 2026 para difundir información sobre estos cambios.

“Sabemos que estos cambios afectarán a muchos de nuestros afiliados”, afirmó Michael Hunn, director ejecutivo de CalOptima, uno de los más de veinte planes de atención médica de Medi-Cal que reciben pagos mensuales en función del número de afiliados. “Tenemos la gran responsabilidad de asegurarnos de que comprendan y puedan adaptarse a estos cambios a medida que se implementan”.

CalOptima, una entidad pública cuyo directorio es nombrado por la junta de supervisores del condado, ha destinado unos $2 millones hasta 2028 para financiar que trabajadores del área de elegibilidad brinden ayuda en eventos comunitarios como la distribución de alimentos. Según An Tran, director de la Agencia de Servicios Sociales del condado de Orange, estos fondos permitirán realizar actividades de divulgación fundamentales que, de otro modo, el condado no podría costear.

El condado de Orange tiene unos 1.500 trabajadores encargados de procesar las reinscripciones y de verificar los datos de aproximadamente  850.000 beneficiarios de Medi-Cal y más de 300.000 inscritos en CalFresh.

“Estamos hablando de familias que necesitan ayuda con urgencia, especialmente en un momento en que los precios de los alimentos y la inflación están tan altos que apenas logran llegar a fin de mes”, dijo Tran.

Además de financiar a trabajadores del condado, CalOptima también planea otorgar subvenciones a organizaciones comunitarias para que realicen actividades de difusión sobre Medi-Cal. Además, desarrollará una campaña de concientización pública en varios idiomas para informar a las personas afiliadas sobre los nuevos requisitos, explicó Hunn.

La representante federal Young Kim, republicana que representa a parte del condado de Orange, no respondió a una solicitud de comentarios, pero ha dicho que la ley presupuestaria firmada por Trump, por la que votó a favor, “toma medidas importantes para asegurar que los fondos federales se usen de la manera más eficaz posible y para fortalecer Medicaid y SNAP para nuestros ciudadanos más vulnerables que realmente lo necesitan”. Kim y otros republicanos han dicho que la ley ofrecerá alivio fiscal a las personas trabajadoras en Estados Unidos.

Después de casi una hora de hablar con una trabajadora del área de elegibilidad, Basu se enteró de que gana demasiado como para que su suegra —quien vive con su familia— califique para CalFresh. Ahora, contó, le preocupan los cambios en los requisitos de Medi-Cal para inmigrantes. Teme que estas modificaciones puedan afectar a su suegra, quien obtuvo la residencia legal permanente hace aproximadamente un año y medio.

“Antes de tener eso, pagábamos en efectivo por el cardiólogo, por los análisis de laboratorio, por todo. Era carísimo”, dijo Basu. “Estoy pensando que en unos meses tendré que volver a pagar todo de mi bolsillo. Es mucho para mí. Es una carga”.

En la mayor parte del país, las personas que tienen residencia permanente (green card) desde hace menos de cinco años suelen no calificar para Medicaid, que es financiado por el gobierno federal. Sin embargo, California ha ofrecido cobertura de Medi-Cal con fondos estatales tanto a esas personas como a inmigrantes de bajos ingresos que no tienen estatus legal.

Pero incluso estos beneficios están siendo recortados por la presión del presupuesto estatal. En julio, el estado eliminará la cobertura completa de servicios dentales a algunos afiliados que tienen tarjeta de residencia desde hace menos de cinco años, así como a ciertos grupos de inmigrantes. Un año después, ese mismo grupo comenzará a pagar cuotas mensuales.

Y desde enero, California congelará la inscripción en Medi-Cal para personas mayores de 19 años sin estatus migratorio legal y para algunos inmigrantes que sí están legalmente en el país. También reinstaurará el límite de bienes para todos los afiliados mayores de edad.

Mientras tanto, el estado está preparando instrucciones para los condados sobre cómo implementar los cambios federales en los requisitos de elegibilidad de Medicaid, dijo Tony Cava, vocero del Departamento de Servicios de Atención Médica de California. Las reglas federales de trabajo y las revisiones de elegibilidad dos veces al año deberán aplicarse desde comienzos de 2027, en particular para quienes están afiliados bajo la expansión de cobertura de la Ley de Cuidado de Salud a Bajo Precio (ACA, por sus siglas en inglés).

El Departamento de Servicios Sociales de California, que administra CalFresh, ya modificó el modo de calcular los costos de servicios públicos del hogar y ha impuesto un límite a los beneficios para hogares muy numerosos. Además, aún está desarrollando las directrices sobre los requisitos federales de trabajo y los cambios que dejan afuera a ciertas personas que no son ciudadanas, indicó el subdirector David Swanson Hollinger durante una audiencia reciente.

El Departamento de Servicios de Salud ha creado una página web titulada Lo que las personas afiliadas a Medi-Cal deben saber sobre los cambios estatales y federales en Medicaid. También está utilizando su red de “embajadores de cobertura de Medi-Cal” para compartir información y actualizaciones en comunidades de todo el estado en varios idiomas. Y está colaborando con los condados y los planes de Medi-Cal para apoyar la inscripción comunitaria, incluso en eventos locales, explicó Cava.

Aquilino y Fidelia Salazar, un matrimonio que recibió ayuda con su solicitud a CalFresh, dijeron que no esperaban verse afectados por los requisitos laborales ni los cambios en la elegibilidad de Medi-Cal, porque ambos son residentes permanentes de EE.UU., tienen enfermedades crónicas y no pueden trabajar. Las personas consideradas incapaces de trabajar por razones físicas o mentales pueden quedar exentas de los requisitos laborales. Pero la pareja expresó preocupación por otras personas inmigrantes de su comunidad, que podrían perder el acceso a atención médica.

“No es justo, porque hay mucha gente que realmente sí lo necesita”, dijo Fidelia Salazar en español. “Ganan tan poquito y luego las medicinas e ir a un doctor es carísimo”.

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They grabbed canned food, fruit and vegetables, and a grocery store gift card. And then Basu spotted a row of tables in the parking lot staffed by county social service workers helping people apply for food assistance and health coverage. Her mother-in-law, also a Medicaid recipient, might qualify for food assistance, she was told.

“It would be less money for me that I would have to put aside,” said Basu, who has been the sole breadwinner for the family from Anaheim since her husband suffered a stroke. “Maybe I can use that extra money to cover other expenses.”

Basu was among the more than 3,000 people who turned up at a November CalOptima event in one of California’s most affluent counties. It marked the start of a $20 million campaign by the Medicaid health insurer to help low-income residents get and maintain health coverage and food benefits as federal restrictions under President Donald Trump’s One Big Beautiful Bill Act take effect.

The law cuts more than $900 billion in federal funding for Medicaid, known in California as Medi-Cal. It also slashes around $187 billion from the Supplemental Nutrition Assistance Program, or SNAP, known as CalFresh in California. That’s about 20% of the program’s budget over the next 10 years. As a result, up to 3.4 million Medi-Cal recipients and almost 400,000 CalFresh beneficiaries could lose benefits. (Most CalFresh beneficiaries also receive Medi-Cal.)

Republican representatives say the changes, some of which have already taken effect, will prevent waste, fraud, and abuse through expanded eligibility checks and work requirements. Yet, Medicaid health plans across the nation are bolstering outreach to low-income households in a bid to not lose enrollees, many of whom are already struggling with high grocery and medical costs.

In Los Angeles County, L.A. Care Health Plan launched community information sessions this month to educate the public about upcoming changes to Medi-Cal. Hawaii’s AlohaCare is mobilizing a covid-era coalition to help mitigate the impact of Medicaid coverage losses. And Community Behavioral Health, a Medicaid managed-care plan for behavioral health in Philadelphia, plans to host a series of summits starting next year to get the word out about the changes.

“We know that these changes will affect a lot of our members,” said Michael Hunn, CEO of CalOptima, one of about two dozen Medi-Cal managed-care plans paid monthly based on their number of enrollees. “We have a great responsibility to make sure that they understand and can navigate these changes as they are implemented.”

CalOptima, a public entity whose board is appointed by county supervisors, has allocated up to $2 million through the end of 2028 to pay for county eligibility workers at events like the food giveaway to provide on-the-spot assistance. It’s funding that An Tran, head of Orange County’s Social Services Agency, said can help pay for critical outreach the county otherwise wouldn’t be able to afford.

Orange County has about 1,500 eligibility workers to handle reenrollments and verification checks for around 850,000 Medi-Cal members and over 300,000 CalFresh recipients.

“We are talking about families who desperately need help especially at a time when food costs and inflation is high and they’re barely able to make it,” Tran said.

In addition to funding county workers, CalOptima intends to provide grants to community organizations to conduct Medi-Cal outreach and run a public awareness campaign in multiple languages to make enrollees aware of new requirements, Hunn said.

U.S. Rep. Young Kim, a Republican who represents part of Orange County, did not respond to a request seeking comment but has said Trump’s signature budget law, which she voted for, “takes important steps to ensure federal dollars are used as effectively as possible and to strengthen Medicaid and SNAP for our most vulnerable citizens who truly need it.” She and other Republicans have said it will provide tax relief for working Americans.

After nearly an hour with an eligibility worker, Basu learned she earned too much for her mother-in-law, who lives with the family, to qualify for CalFresh. Now, Basu said, she’s worried about Medi-Cal eligibility changes for immigrants, which she fears could affect her mother-in-law, who obtained lawful permanent residency about a year and a half ago.

“Before having that, we were paying cash for cardiology, for labs, everything. It was very pricey,” Basu said. “I’m thinking I will have to, in a few months, pay again out-of-pocket. It’s a lot on me. It’s a burden.”

In most of the nation, people who’ve had a green card for less than five years generally don’t qualify for federally funded Medicaid. However, California has provided state-funded Medi-Cal coverage for them and low-income immigrants without legal status.

But even those benefits are being rolled back amid state budget pressures. In July, the state will eliminate full-scope dental benefits for some enrollees who have had a green card for less than five years, as well as certain other immigrant enrollees. A year later, this group will start being charged monthly premiums.

And starting in January, California will freeze enrollment for people 19 or over without legal status, as well as some lawfully present immigrants. It will also reinstate an asset limit for all older enrollees.

Meanwhile, the state is drafting guidance for counties on how to implement the federal Medicaid eligibility changes, said Tony Cava, a spokesperson for California’s Department of Health Care Services. The federal work rules and twice-yearly eligibility checks are slated to take effect by the start of 2027, applying to enrollees under the Affordable Care Act coverage expansion.

The California Department of Social Services, which manages CalFresh, has already changed how home utility costs are calculated and imposed a cap on benefits for very large households. It is still developing guidance for the federal work requirements and changes that disqualify some noncitizens, agency Chief Deputy Director David Swanson Hollinger said at a recent hearing.

The Department of Health Care Services has developed a “What Medi-Cal Members Need to Know” webpage about the state and federal Medicaid changes. It’s also leveraging a network of Medi-Cal “coverage ambassadors” to provide information and updates in communities across the state in multiple languages. And it’s collaborating with counties and Medi-Cal managed-care plans to support community-based enrollment assistance, including at local events, Cava said.

Aquilino and Fidelia Salazar, a husband and wife getting help with a CalFresh application, said they didn’t expect to be affected by the work requirements and Medi-Cal eligibility changes. That’s because they are both permanent U.S. residents who have chronic health conditions and can’t work, they said. People considered physically or mentally unable to work can be exempted from work requirements. But the couple are concerned other immigrants in their community could lose care.

“It’s not fair because a lot of people really need it,” Fidelia Salazar said in Spanish. “People earn so little and then medicines and going to the doctor is extremely expensive.”

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Durante dos semanas, contratistas del Servicio de Inmigración y Control de Aduanas (ICE) hicieron guardia en el vestíbulo del hospital las 24 horas del día. Se tomaron turnos para vigilar sus movimientos, contó Ming Tanigawa-Lau, la abogada de Solís-Portillo.

Luego, el ICE trasladó a la mujer salvadoreña al Anaheim Global Medical Center, en contra de las indicaciones médicas y sin dar ninguna explicación, según dijo la abogada.

Tanigawa-Lau contó que allí les permitieron a los agentes del ICE quedarse dentro de la habitación de Solís-Portillo todo el tiempo, escuchando conversaciones entre la paciente y el personal médico que deberían haber sido privadas.

Solís-Portillo le dijo a su abogada que los agentes la presionaron para que dijera que estaba lo suficientemente bien como para salir del hospital, advirtiéndole que no podría comunicarse ni con su familia ni con su abogada hasta que aceptara irse.

“Me lo describió como una situación en la que sentía que la estaban torturando”, enfatizó Tanigawa-Lau.

Expertos legales explican que los agentes del ICE pueden estar en áreas públicas de un hospital, como el vestíbulo, y pueden acompañar a pacientes que ya están detenidos mientras reciben atención médica, lo que refleja el alcance de la autoridad federal.

Sin embargo, los pacientes detenidos tienen derechos y pueden tratar de defenderse por sí mismos o buscar ayuda legal.

Este año, California destinó $25 millones para financiar servicios legales para inmigrantes, y algunas jurisdicciones locales —incluidos el condado de Orange, Long Beach y San Francisco— también han asignado fondos para iniciativas de ayuda legal. El Departamento de Servicios Sociales de California enumera algunas organizaciones sin fines de lucro que han recibido estos fondos.

Sophia Genovese, abogada supervisora y profesora clínica en la Facultad de Derecho de Georgetown, explicó que los agentes del orden, incluidos los agentes federales de inmigración, pueden custodiar e incluso mantener esposada a una persona bajo su custodia mientras recibe atención médica.

Pero deben cumplir con las leyes constitucionales y de privacidad médica, sin importar el estatus migratorio del paciente. Según esas normas, los pacientes pueden pedir hablar en privado con los proveedores médicos y tener acceso confidencial a asesoría legal, explicó Genovese.

“ICE debe ubicarse fuera de la habitación o fuera del alcance auditivo durante cualquier conversación entre el paciente y su doctor o proveedor de salud”, dijo Genovese, y agregó que lo mismo aplica a las comunicaciones con abogados. “Eso es lo que se supone que deben hacer”.

Guías de ICE

En cuanto a la comunicación y las visitas, las normas del ICE establecen que los detenidos deben tener acceso a un teléfono y poder recibir visitas de familiares y amigos, “dentro de las limitaciones operativas y de seguridad”. Sin embargo, Genovese dijo que esas pautas no se exigen por ley.

Si los agentes de inmigración arrestan a una persona sin una orden judicial, deben informarle el motivo de la detención y, por lo general, no pueden retenerla más de 48 horas sin tomar una decisión formal sobre su custodia.

Un juez federal concedió recientemente una orden de restricción temporal en un caso en el que un hombre llamado Bayron Rovidio Marín fue vigilado por agentes de inmigración en un hospital de Los Ángeles durante 37 días sin que se le presentaran cargos.

En el pasado, si se percibían violaciones por parte de los agentes, se podían reportar a las oficinas locales del ICE, a la sede de la agencia o a organismos de supervisión, explicó Genovese.

Pero este año el Departamento de Seguridad Nacional (DHS) redujo el personal de las oficinas del ombudsman que investigan denuncias por violaciones a los derechos civiles, argumentando que esas oficinas “obstruían la aplicación de las leyes migratorias al agregar trabas burocráticas”.

Tricia McLaughlin, secretaria adjunta de asuntos públicos del DHS, dijo que los agentes arrestaron a Marín por estar en el país ilegalmente y que él mismo admitió su estatus migratorio ante los agentes del ICE. McLaughlin dijo que lo llevaron al hospital luego de que se lastimara una pierna mientras intentaba escapar de los oficiales federales durante una redada.

McLaughlin señaló que los agentes no le impidieron comunicarse con su familia ni usar el teléfono.

“Todos los detenidos tienen acceso a teléfonos que pueden usar para comunicarse con sus familias y abogados”, agregó.

McLaughlin calificó como “activista” a la jueza que emitió la orden de restricción temporal. No respondió a preguntas sobre los recortes de personal en las oficinas del ombudsman.

El DHS también dijo que Solís-Portillo estaba en el país sin autorización. Según el departamento, había sido expulsada de Estados Unidos en dos ocasiones y había sido arrestada por los delitos de uso de identificación falsa, robo y entrada en una vivienda ilegalmente.

“El ICE se toma muy en serio su compromiso de ofrecer entornos seguros, protegidos y humanos para quienes están bajo nuestra custodia”, dijo McLaughlin. “Desde que una persona entra bajo custodia del ICE, es práctica de larga data proveer atención médica integral, lo que incluye acceso a citas médicas y atención de emergencia las 24 horas”.

Protecciones en California

El Anaheim Global Medical Center no respondió a un pedido de comentarios.

En un comunicado, Dignity Health, que opera el Glendale Memorial Hospital, afirmó que “legalmente no puede restringir la presencia de personal de seguridad o agentes del orden en áreas públicas, lo que incluye el vestíbulo o las salas de espera del hospital”.

En septiembre, California aprobó una ley que prohíbe a los establecimientos médicos permitir la entrada de agentes federales a áreas privadas —incluyendo espacios donde los pacientes reciben atención o discuten temas de salud— si no presentan una orden de cateo o un mandato judicial válido.

Sin embargo, muchas de las noticias más destacadas sobre la presencia de agentes de migración en centros de salud han involucrado a pacientes detenidos que fueron trasladados para recibir atención.

Erika Frank, vicepresidenta de asesoría legal de la California Hospital Association, dijo que los hospitales siempre han recibido personas detenidas que necesitan atención médica por parte de las autoridades, incluidos agentes federales.

Según Jan Emerson-Shea, vocera de la asociación, son las autoridades quienes deciden si un paciente necesita ser vigilado todo el tiempo. Si un agente del orden escucha información médica mientras está presente en el hospital, eso no constituye una violación de la privacidad del paciente, agregó.

“Legalmente, no es diferente de que otro paciente o visitante escuche información sobre alguien en una cama cercana o en una sala de emergencias”, dijo Emerson-Shea en un comunicado.

No respondió si los pacientes pueden exigir privacidad con el personal médico o con sus abogados, y señaló que los hospitales no informan a familiares o amigos sobre la ubicación del paciente detenido, por razones de seguridad.

Sandy Reding, presidenta de la California Nurses Association, visitó las instalaciones de Glendale cuando Solís-Portillo estuvo internada. Contó que tanto enfermeras como pacientes se sintieron intimidados al ver agentes de inmigración con máscaras en el vestíbulo del hospital. Dijo que los vio sentados detrás del escritorio donde se registran los pacientes, desde donde podían escuchar conversaciones sobre información médica privada.

“Los hospitales solían ser un lugar seguro, y ahora ya no lo son”, dijo. “Y parece que el ICE actúa sin restricciones”.

La Junta de Supervisores del Condado de Los Ángeles tiene previsto votar el 18 de noviembre una propuesta para brindar mayor protección a las personas detenidas en centros de salud administrados por el condado. Estas medidas incluyen limitar la capacidad de los funcionarios de inmigración para ocultar la identidad de los pacientes, permitir que estos den su consentimiento para la divulgación de información a familiares y abogados, e instruir al personal para que exija que los agentes de inmigración abandonen la habitación en determinados momentos para proteger la privacidad de los pacientes. El condado también defenderá a los empleados que intenten hacer cumplir sus políticas.

La abogada de Solís-Portillo, Tanigawa-Lau, dijo que su clienta finalmente decidió regresar voluntariamente a El Salvador en lugar de pelear su caso, porque sentía que no podía recibir la atención médica que necesitaba mientras estuviera bajo la custodia del ICE.

“Aunque el caso de Milagro es realmente terrible, me alegra que ahora haya más conciencia sobre este tema”, afirmó Tanigawa-Lau.

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For two weeks, Immigration and Customs Enforcement contractors sat guard in the hospital lobby 24 hours a day, working in shifts to monitor her movements, her attorney Ming Tanigawa-Lau said.

ICE later transferred the Salvadoran woman to Anaheim Global Medical Center, against her doctor’s orders and without explanation, her attorney said. There, Tanigawa-Lau said, ICE agents were allowed to stay in Solis-Portillo’s hospital room round-the-clock, listening to what should have been private conversations with providers. Solis-Portillo told her attorney that agents pressured her to say she was well enough to leave the hospital, telling her she wouldn’t be able to speak to her family or her attorney until she complied.

“She described it to me as feeling like she was being tortured,” Tanigawa-Lau said.

Legal experts say ICE agents can be in public areas of a hospital, such as a lobby, and can accompany already-detained patients as they receive care, illustrating the scope of federal authority. Detained patients, however, have rights and can try to advocate for themselves or seek legal recourse.

Earlier this year, California set aside $25 million to fund legal services for immigrants, and some local jurisdictions — including Orange County, Long Beach, and San Francisco — have put money toward legal aid efforts. The California Department of Social Services lists some legal defense nonprofits that have received funds.

Sophia Genovese, a supervising attorney and clinical teaching fellow at Georgetown Law, said law enforcement officers, including federal immigration agents, can guard and even restrain a person in their custody who is receiving health care, but they must follow constitutional and health privacy laws regardless of the person’s immigration status. Under those laws, patients can ask to speak with medical providers in private and to seek and speak confidentially with legal counsel, she said.

“ICE should be stationed outside of the room or outside of earshot during any communication between the patient and their doctor or medical provider,” Genovese said, adding that the same applies to a patient’s communication with lawyers. “That’s what they’re supposed to do.”

ICE Guidelines

When it comes to communication and visits, ICE’s standards state that detainees should have access to a phone and be able to receive visits from family and friends, “within security and operational constraints.” However, these guidelines are not enforceable, Genovese said.

If immigration agents arrest someone without a warrant, they must tell them why they’ve been detained and generally can’t hold them for more than 48 hours without making a custody determination. A federal judge recently granted a temporary restraining order in a case in which a man named Bayron Rovidio Marin was monitored by immigration agents in a Los Angeles hospital for 37 days without being charged and was registered under a pseudonym.

In the past, perceived violations by agents could be reported to ICE leadership at local field offices, to the agency’s headquarters, or to an oversight body, Genovese said. But earlier this year, the Department of Homeland Security cut staffing at ombudsman offices that investigate civil rights complaints, saying they “obstructed immigration enforcement by adding bureaucratic hurdles.”

The assistant secretary for public affairs at DHS, Tricia McLaughlin, said that agents arrested Marin for being in the country illegally and that he admitted his lack of legal status to ICE agents. She said agents took him to the hospital after he injured his leg while trying to evade federal officers during a raid. She said officers did not prevent him from seeing his family or from using the phone.  

“All detainees have access to phones they can use to contact their families and lawyers,” she said.

McLaughlin said the temporary restraining order was issued by an “activist” judge. She did not address questions about staffing cuts at the ombudsman offices.

DHS also said Solis-Portillo was in the country illegally. The department said she had been removed from the United States twice and arrested for the crimes of false identification, theft, and burglary.

“ICE takes its commitment to promoting safe, secure, humane environments for those in our custody very seriously,” McLaughlin said. “It is a long-standing practice to provide comprehensive medical care from the moment an alien enters ICE custody. This includes access to medical appointments and 24-hour emergency care.”

Protections in California

Anaheim Global Medical Center did not respond to a request for comment. In a statement, Dignity Health, which operates Glendale Memorial Hospital, said it “cannot legally restrict law enforcement or security personnel from being present in public areas which include the hospital lobby/waiting area.”

California enacted a law in September that prohibits medical establishments from allowing federal agents without a valid search warrant or court order into private areas, including places where patients receive treatment or discuss health matters. But many of the most high-profile news reports of immigration agents at health care facilities have involved detained patients brought in for care.

Erika Frank, vice president of legal counsel for the California Hospital Association, said hospitals have always had law enforcement, including federal agents, bring in people they’ve detained who need medical attention.

Hospitals will defer to law enforcement on whether a patient needs to be monitored at all times, according to association spokesperson Jan Emerson-Shea. If law enforcement officers overhear medical information about a patient while they’re in the hospital, it doesn’t constitute a patient-privacy violation, she added.

“This is no different, legally, from a patient or visitor overhearing information about another patient in a nearby bed or emergency department bay,” Emerson-Shea said in a statement.

She didn’t address whether patients can demand privacy with providers and attorneys, and she said hospitals don’t tell family and friends about the detained patient’s location, for safety reasons.

Sandy Reding, who is president of the California Nurses Association and visited the Glendale facility when Solis-Portillo was there, said nurses and patients were frightened to see masked immigration agents in the hospital’s lobby. She said she saw them sitting behind a registration desk where they could hear people discuss private health information.

“Hospitals used to be a sanctuary place, and now they’re not,” she said. “And it seems like ICE has just been running rampant.”

The Los Angeles County Board of Supervisors is scheduled to vote Nov. 18 on a proposal to provide more protections for detainees at county-operated health facilities. These include limiting the ability of immigration officials to hide patients’ identities, allowing patients to consent to the release of information to family members and legal counsel, and directing staff to insist immigration agents leave the room at times to protect patient privacy. The county would also defend employees who try to uphold its policies.

Solis-Portillo’s lawyer, Tanigawa-Lau, said her client ultimately decided to self-deport to El Salvador rather than fight her case, because she felt she couldn’t get the medical care she needed in ICE custody.

“Even though Milagro’s case is really terrible, I’m glad that there’s more awareness now about this issue,” Tanigawa-Lau said.

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At a forum Nov. 7 in the Inland Empire, four Democratic candidates vying to succeed Gov. Gavin Newsom vowed to push back against Republican cuts to health care programs and to improve people’s access to medical care, including mental health services. But while some floated taxes, candidates were light on details about how they would bring down health care costs.

Former U.S. Health and Human Services Secretary Xavier Becerra promised to be California’s next “health care governor,” echoing Newsom’s commitment to lower costs and broaden access when he first got into office. State Superintendent of Public Instruction Tony Thurmond pledged to create a single-payer health care system in which everyone is pooled into one program. Former state Controller Betty Yee said she would “build back better” from federal cuts and create a health care system tailored to California’s diverse communities.

And former Los Angeles Mayor Antonio Villaraigosa vowed to fight to preserve safety net health care pared by the Trump administration and Republicans in Congress, although he acknowledged the challenge given limited state resources.

“I’m not gonna sell you snake oil,” he said. “It is going to be tough to provide that care, but I’m absolutely committed to it.”

The candidates’ assurances come amid recent shifts in state and federal policies that, together with a variety of forces, are driving up the cost of health care and making it harder for people to obtain and maintain coverage. In addition to providers raising prices, other inflationary pressures include an aging population, rising chronic conditions, medical advancements, and new technologies, according to analysts. That’s added to a sense of financial precarity for the millions of Californians struggling with the state’s high cost of living and recent inflation spike.

Although the forum was open to up to six candidates, former U.S. Rep. Katie Porter and entrepreneur Stephen Cloobeck declined to participate, citing scheduling or other factors, according to Jon Koriel, an event spokesperson.

Health Care Top Concern

A statewide poll commissioned by the California Wellness Foundation ahead of the Health Matters forum found that nearly 80% of likely voters worry about the cost of health care and that 72% think the next governor should prioritize capping out-of-pocket expenses. Access to affordable mental health care and being able to care for aging family members or friends were also top concerns. Perhaps in an early signal, voters last week in Santa Clara County passed a sales tax to help backfill federal cuts to food and health care safety net programs.

California mirrors much of the nation. Exit polls from the Nov. 4 election show 81% of those who voted for Democrat Abigail Spanberger, winner of the Virginia governor’s race, cited health care as the most important issue facing the state. In a national Reuters/Ipsos poll, health care was cited as the top everyday expense Americans want Congress to prioritize. And 65% of voters said an annual health cost increase of $1,000 would have some impact on their 2026 vote, according to a recent KFF poll.

Some Californians interviewed on Nov. 4, the day of the state’s special election, expressed disappointment in Newsom’s unmet promises on health care. Newsom, a Democrat who is mulling a presidential run as he wraps up his second term in January 2027, had campaigned on single-payer health care.

During his tenure he’s steered billions of dollars and engineered rules to help the neediest Californians afford and access health care. The state also expanded state-funded Medicaid coverage, known as Medi-Cal, to all eligible residents, regardless of immigration status. Medicaid provides free or low-cost health insurance to low-income and disabled people.

But this year, facing rising costs and budget deficits, Newsom and the Democratic-controlled legislature walked back some of that expansion by freezing enrollment for adults without legal status starting in 2026 and implementing premiums. They also resurrected an asset test for older adults and people with disabilities. Meanwhile, health care costs and homelessness remain a huge problem, and many Californians struggle to get basic medical care. And there’s no sign of a single-payer health care system, which Sacramento lawmakers have repeatedly failed to advance amid concerns about cost, including one estimate in 2017 of $400 billion annually.

“I remember him coming and speaking to our members and telling them that he was going to fight with them for single payer,” Michael Cusack, a 30-year-old former health care union worker from Oakland, said as he cast his ballot last week. “And I never saw him deliver on that campaign.”

Paying for Health Care

Becerra, Thurmond, and Yee said they would be open to raising taxes to pay for health care programs. Villaraigosa sidestepped the tax question, saying his focus would be to “grow the pie” economically. Yee also suggested offering tax credits to help struggling families pay for health care and caregiving expenses.

During the forum’s lightning round, Becerra, Thurmond, and Yee also raised their hands when asked whether they supported single-payer care. Becerra said after the event that he doesn’t believe the state would receive support from the Trump administration for a single-payer system, but he said he would push for universal access to health care.

Indeed, all the candidates appeared mindful of Washington’s power over health care resources, even as they vowed to stand up to President Donald Trump, who has an especially adversarial relationship with Newsom.

“Let’s recognize that the federal government is our largest partner,” Becerra said. “We must work with them. We will not take a knee, but we must work with them.”

Currently, the biggest threats to health care costs and accessibility come from the federal government. Republicans in Congress have refused to give in to Democrats’ demand to extend premium tax subsidies for health insurance plans purchased on Affordable Care Act exchanges, the main issue that drove the government shutdown. Enrollees in Covered California, the state’s health insurance exchange, have received notices that their premiums will increase next year. On average, monthly premium payments for people receiving ACA subsidies are expected to double across the nation.

Laura Jones, a small-business owner in Oakland, currently pays the minimum possible for her Covered California plan, but she worries she wouldn’t be able to afford a major medical emergency. She thinks about one of her friends who recently suffered a stroke.

“The hospital bills were just so egregious,” Jones said. “How would I pay for that?”

Meanwhile, an impending $900 billion in federal Medicaid spending reductions under the One Big Beautiful Bill Act and tighter eligibility restrictions are expected to push as many as 3.4 million Californians out of the program. More than a third of Californians are currently enrolled in Medi-Cal.

Oseoba Airewele, 29, of Ventura, a registered Democrat who previously worked as a software engineer, said Medi-Cal became a lifeline after he lost insurance through his job and needed mental health and dental care.

“If I were to lose it, I would be very concerned,” he said. “I’d be in a bad place.”

People with employer-based health coverage also face steep price hikes. Family premiums for employer-based plans averaged almost $27,000 this year, up 6% from 2024, a new KFF report shows. Workers typically pay almost $7,000 of that, the report found. That doesn’t include other out-of-pocket expenses.

“Even though I have a job, it’s still really expensive to pay for the copays,” said Rheema Calloway, 35, a San Francisco independent.

Primary in June

Among the other Democratic candidates vying for governor in 2026, Porter has said she will make fighting federal cuts to Medicaid and Medicare a top priority, along with expanding and improving health care for all residents. Porter’s campaign suffered a blow after viral videos surfaced of her threatening to walk out of a CBS interview and berating a staff member. Former Assemblyman Ian Calderon has said he would protect access to Medi-Cal. And Cloobeck wants to fast-track housing construction.

Republican candidates include Riverside County Sheriff Chad Bianco and Steve Hilton, a former Fox News contributor and policy adviser to David Cameron when he was Britain’s prime minister. Both have pledged to tackle affordability issues, especially housing costs.

Two other high-profile Democrats — former Vice President Kamala Harris and U.S. Sen. Alex Padilla — have said they won’t run. Rick Caruso, a Republican-turned-Democrat and wealthy Los Angeles businessman, has yet to decide whether to run.

The California primary will be held June 2 and the general election on Nov. 3.

KFF Health News correspondent Christine Mai-Duc and ethnic media editor Ngoc Nguyen contributed to this report.

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Agentes del Servicio de Inmigración y Control de Aduanas (ICE) también se han presentado en clínicas comunitarias.

Proveedores de salud dicen que intentaron entrar en un estacionamiento donde había una clínica móvil, apuntaron a las caras de médicos que atendían a personas sin hogar y detuvieron a un transeúnte, subiéndolo a un auto sin identificación, frente a un centro comunitario de salud.

En respuesta a estas actividades de control migratorio alrededor de clínicas y hospitales, el gobernador demócrata Gavin Newsom promulgó el mes pasado la ley SB 81, que prohíbe a los centros médicos permitir el acceso de agentes federales a áreas privadas, incluidos los lugares donde los pacientes reciben tratamiento o hablan sobre temas de salud, sin una orden judicial o de registro válidas.

Si bien el proyecto de ley recibió un amplio apoyo de grupos médicos, trabajadores de salud y defensores de los derechos de los inmigrantes, expertos legales afirman que California no puede impedir que las autoridades federales realicen sus funciones en lugares públicos, como vestíbulos y salas de espera de hospitales, estacionamientos de centros de salud y vecindarios aledaños: lugares donde las recientes actividades del ICE han generado indignación y temor.

En enero, la administración Trump revocó las restricciones federales previas sobre la aplicación de las leyes de inmigración en o cerca de áreas sensibles, incluidos los establecimientos de salud.

“El problema que enfrentan los estados es la cláusula de supremacía”, dijo la abogada Sophia Genovese, profesora en la Facultad de Leyes de Georgetown. Explicó que el gobierno federal tiene derecho a realizar actividades de control migratorio y que existen límites a lo que el estado puede hacer para impedirlas.

La ley de California designa el estatus migratorio y el lugar de nacimiento de un paciente como información protegida, la cual, al igual que los expedientes médicos, no puede divulgarse a las autoridades sin una orden judicial.

Además, requiere que los centros de salud establezcan procedimientos claros para gestionar los pedidos de las autoridades de inmigración, incluyendo la capacitación del personal para notificar de inmediato a un administrador designado o a un asesor legal si los agentes intentan entrar a un área privada o revisar los expedientes de los pacientes.

Otros estados gobernados por demócratas han promulgado leyes para proteger a los pacientes en hospitales y centros de salud.

En mayo, el gobernador de Colorado, Jared Polis, promulgó la  Protect Civil Rights Immigration Status, que penaliza a los hospitales por compartir sin autorización información sobre personas que se encuentran en el país de manera irregular y prohíbe a los agentes del ICE ingresar a áreas privadas de los centros de salud sin una orden judicial.

En junio, entró en vigencia en Maryland una ley que exige al fiscal general crear directrices para mantener al ICE fuera de los centros de salud. Nuevo México ha implementado nuevas protecciones para los datos de pacientes, y Rhode Island ha prohibido a los establecimientos de salud preguntar a los pacientes sobre su estatus migratorio.

Los estados gobernados por republicanos se han alineado con los esfuerzos federales para evitar que se gaste en atención médica de inmigrantes sin papeles.

Estos inmigrantes no son elegibles para la cobertura integral de Medicaid, pero los estados sí facturan al gobierno federal por la atención de emergencia en ciertos casos. Bajo una ley que entró en vigencia en 2023, Florida exige que los hospitales que aceptan Medicaid pregunten sobre el estatus migratorio del paciente. En Texas, los hospitales ahora deben informar cuánto gastan en la atención de inmigrantes indocumentados.

“Los texanos no deberían tener que asumir el costo de la atención médica de los inmigrantes ilegales”, declaró el gobernador Greg Abbott al emitir su orden ejecutiva el año pasado.

Los esfuerzos de California por limitar la aplicación de la ley federal se producen en un momento en que el estado, donde más de una cuarta parte de los residentes han nacido en el extranjero, se ha convertido en blanco de la represión migratoria del presidente Donald Trump.

Newsom promulgó la SB 81 como parte de un paquete de leyes que prohíbe a los agentes de inmigración entrar en las escuelas sin una orden judicial, exige que los agentes se identifiquen y prohíbe el uso de máscaras. La SB 81 se aprobó con una votación partidista sin oposición formal.

“No somos Corea del Norte”, expresó Newsom durante una ceremonia de firma de leyes en septiembre. “Estamos rechazando estas tendencias y acciones autoritarias de esta administración”.

Algunos partidarios del proyecto de ley y expertos legales afirmaron que la ley de California puede impedir que el ICE viole los derechos de privacidad de los pacientes ya existentes.

Entre estos derechos se incluye la Cuarta Enmienda, que prohíbe los registros sin orden judicial en lugares donde las personas tienen una expectativa razonable de privacidad. Las órdenes judiciales válidas deben ser emitidas por un tribunal y firmadas por un juez. Sin embargo, con frecuencia los agentes del ICE utilizan órdenes administrativas para intentar acceder a áreas privadas para las que no tienen autoridad, dijo Genovese.

“La gente no siempre entiende la diferencia entre una orden administrativa, que es un simple documento, y una orden judicial, que es ejecutable”, dijo Genovese. Añadió que las órdenes judiciales rara vez se emiten en casos de inmigración.

El Departamento de Seguridad Nacional (DHS) ha dicho que no acatará la prohibición del uso de máscaras ni los requisitos de identificación para los agentes del orden público en California, calificándolos de inconstitucionales. El departamento no respondió a la solicitud de comentarios sobre las nuevas normas estatales para centros de salud, que entraron en vigencia de inmediato.

Tanya Broder, asesora principal del National Immigration Law Center, afirmó que las detenciones de inmigrantes en centros de salud parecen ser relativamente raras. Sin embargo, la decisión federal de revocar las protecciones en torno a áreas sensibles, dijo, “ha generado temor e incertidumbre en todo el país”.

Muchos de los informes periodísticos más destacados sobre agentes de inmigración en centros de salud ocurrieron en California, principalmente en relación con pacientes detenidos que habían sido trasladados a un establecimiento de salud para recibir atención médica.

La California Nurses Association, el sindicato de enfermeras más grande del estado, copatrocinó el proyecto de ley y expresó su preocupación por el trato que recibió Milagro Solis-Portillo, una salvadoreña de 36 años que estuvo bajo vigilancia constante del ICE en el Hospital Glendale Memorial durante el verano.

Los líderes sindicales también condenaron la presencia de agentes en el California Hospital Medical Center, al sur del centro de Los Ángeles. Según Anne Caputo-Pearl, enfermera de parto y representante sindical principal del hospital, los agentes llevaron a una paciente el 21 de octubre y permanecieron en su habitación durante casi una semana. El diario Los Angeles Times informó que a Carlitos Ricardo Parias, creador de contenido de TikTok, lo llevaron al hospital ese mismo día tras resultar herido durante un operativo de control migratorio en el sur de Los Ángeles.

La presencia del ICE intimidó tanto a enfermeras como a pacientes, aseguró Caputo-Pearl, y motivó restricciones de visitas en el hospital. “Queremos una explicación más clara”, dijo. “¿Por qué se permite que estos agentes estén en la habitación?”.

Sin embargo, representantes de hospitales y clínicas dijeron que ya cumplen con los requisitos de la ley, los cuales refuerzan en gran medida las extensas directrices publicadas por el fiscal general del estado, Rob Bonta, en diciembre.

Las clínicas comunitarias a lo largo del condado de Los Ángeles, que atienden a más de dos millones de pacientes al año, incluyendo una gran proporción de inmigrantes, han estado implementando las directrices del fiscal general durante meses, según dijo Louise McCarthy, presidenta y directora ejecutiva de la Asociación de Clínicas Comunitarias del Condado de Los Ángeles.

Agregó que la ley debería ayudar a garantizar estándares unificados en todos los establecimientos de salud a los que las clínicas derivan pacientes y brindarles la tranquilidad de que hay procedimientos para protegerlos.

Aun así, no se puede evitar que se produzcan redadas migratorias en la comunidad, lo que ha provocado que algunos pacientes e incluso trabajadores de salud teman salir a la calle, señaló McCarthy. Se han producido algunos incidentes cerca de clínicas, incluyendo el arresto de un transeúnte frente a una clínica en el este de Los Ángeles, que un guardia de seguridad grabó en video, contó.

“Hemos escuchado a personal de las clínicas preguntar: ‘¿Es seguro para mí salir?'”, dijo.

En St. John’s Community Health, una red de 24 centros de salud comunitarios y cinco clínicas móviles en el sur de Los Ángeles y el Inland Empire, el director ejecutivo Jim Mangia coincidió en que la nueva ley no puede prevenir toda la actividad de control migratorio, pero afirmó que sí les brinda a las clínicas una herramienta para defenderse si se presentan agentes, algo que su personal ya ha tenido que hacer.

Mangia dijo que el personal de St. John’s tuvo dos encuentros con agentes de inmigración durante el verano. En uno de ellos, impidió que agentes armados ingresaran a un estacionamiento con rejas en un centro de rehabilitación de adicciones donde médicos y enfermeras atendían a pacientes en una clínica móvil.

Otro incidente ocurrió en julio, cuando agentes de inmigración llegaron a MacArthur Park a caballo y en vehículos blindados, en una demostración de fuerza por parte del gobierno de Trump.

Mangia dijo que agentes enmascarados con equipo táctico completo rodearon una carpa de atención médica callejera donde el personal de St. John’s atendía a personas sin hogar, les gritaron que se fueran y les apuntaron con un arma. Según Mangia, los proveedores quedaron tan conmocionados por el incidente que tuvieron que recurrir a profesionales de salud mental para ayudarlos a sentirse seguros al regresar de nuevo a la calle.

Un vocero del DHS declaró a CalMatters que, en raras ocasiones, cuando los agentes entran a ciertos lugares sensibles, los oficiales necesitan la aprobación de un supervisor secundario.

Desde entonces, St. John’s ha intensificado sus esfuerzos para brindar apoyo y capacitación al personal y ha ofrecido a los pacientes con miedo a salir la opción de visitas médicas a domicilio y entrega de alimentos. Los temores de los pacientes y la actividad del ICE han disminuido desde el verano, afirmó Mangia, pero con el DHS planeando contratar a 10.000 agentes adicionales, duda que esta situación se mantenga.

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U.S. Immigration and Customs Enforcement agents have also shown up at community clinics. Health providers say that officers have tried to enter a parking lot hosting a mobile clinic, waved a machine gun in the faces of clinicians serving the homeless, and hauled a passerby into an unmarked car outside a community health center.

In response to such immigration enforcement activity in and around clinics and hospitals, Democratic Gov. Gavin Newsom last month signed SB 81, which prohibits medical establishments from allowing federal agents without a valid search warrant or court order into private areas, including places where patients receive treatment or discuss health matters.

But while the bill received broad support from medical groups, health care workers, and immigrant rights advocates, legal experts say California can’t stop federal authorities from carrying out duties in public places, which include hospital lobbies and general waiting areas, health facility parking lots, and surrounding neighborhoods — places where recent ICE activities have sparked outrage and fear. Previous federal restrictions on immigration enforcement in or near sensitive areas, including health care establishments, were rescinded by the Trump administration in January.

“The issue that states encounter is the supremacy clause,” said Sophia Genovese, a supervising attorney and clinical teaching fellow at Georgetown Law. She said the federal government does have the right to conduct enforcement activities, and there are limits to what the state can do to stop them.

California’s law designates a patient’s immigration status and birthplace as protected information, which like medical records cannot be disclosed to law enforcement without a warrant or court order. And it requires health care facilities to have clear procedures for handling requests from immigration authorities, including training staff to immediately notify a designated administrator or legal counsel if agents ask to enter a private area or review patient records.

Several other Democratic-led states have also taken up legislation to protect patients at hospitals and health centers. In May, Colorado Gov. Jared Polis signed the Protect Civil Rights Immigration Status bill, which penalizes hospitals for unauthorized sharing of information about people in the country illegally and bars ICE agents from entering private areas of health care facilities without a judicial warrant. In Maryland, a law requiring the attorney general to create guidance on keeping ICE out of health care facilities went into effect in June. New Mexico has instituted new patient data protections, and Rhode Island has prohibited health care facilities from asking patients about their immigration status.

Republican-led states have aligned with federal efforts to prevent health care spending on immigrants without legal authorization. Such immigrants are not eligible for comprehensive Medicaid coverage, but states do bill the federal government for emergency care in certain cases. Under a law that took effect in 2023, Florida requires hospitals that accept Medicaid to ask about a patient’s legal status. In Texas, hospitals now have to report how much they spend on care for immigrants without legal authorization.

“Texans should not have to shoulder the burden of financially supporting medical care for illegal immigrants,” Gov. Greg Abbott said in issuing his executive order last year.

California’s efforts to rein in federal enforcement come as the state, where more than a quarter of residents are foreign-born, has become a target of President Donald Trump’s immigration crackdown. Newsom signed SB 81 as part of a bill package prohibiting immigration agents from entering schools without a warrant, requiring law enforcement officers to identify themselves, and banning officers from wearing masks. SB 81 was passed on a party-line vote with no formal opposition.

“We’re not North Korea,” Newsom said during a September bill-signing ceremony. “We’re pushing back against these authoritarian tendencies and actions of this administration.”

Some supporters of the bill and legal experts said California’s law can prevent ICE from violating existing patient privacy rights. Those include the Fourth Amendment, which prohibits searches without a warrant in places where people have a reasonable expectation of privacy. Valid warrants must be issued by a court and signed by a judge. But ICE agents frequently use administrative warrants to try to gain access to private areas they don’t have the authority to enter, Genovese said.

“People don’t always understand the difference between an administrative warrant, which is a meaningless piece of paper, versus a judicial warrant that is enforceable,” Genovese said. Judicial warrants are rarely issued in immigration cases, she added.

The Department of Homeland Security has said it won’t abide by California’s mask ban or identification requirements for law enforcement officers, slamming them as unconstitutional. The department did not respond to a request for comment on the state’s new rules for health care facilities, which went into immediate effect.

Tanya Broder, a senior counsel with the National Immigration Law Center, said immigration arrests at health care facilities appear to be relatively rare. But the federal decision to rescind protections around sensitive areas, she said, “has generated fear and uncertainty across the country.” Many of the most high-profile news reports of immigration agents at health care facilities have been in California, largely involving detained patients brought in for care.

The California Nurses Association, the state’s largest nurses union, was a co-sponsor of the bill and raised concerns about the treatment of Milagro Solis-Portillo, a 36-year-old Salvadoran woman who was under round-the-clock ICE surveillance at Glendale Memorial Hospital over the summer.

Union leaders also condemned the presence of agents at California Hospital Medical Center south of downtown Los Angeles. According to Anne Caputo-Pearl, a labor and delivery nurse and the chief union representative at the hospital, agents brought in a patient on Oct. 21 and remained in the patient’s room for almost a week. The Los Angeles Times reported that a TikTok streamer, Carlitos Ricardo Parias, was taken to the hospital that day after he was wounded during an immigration enforcement operation in South Los Angeles.

The presence of ICE was intimidating for nurses and patients, Caputo-Pearl said, and prompted visitor restrictions at the hospital. “We want better clarification,” she said. “Why is it that these agents are allowed to be in the room?”

Hospital and clinic representatives, however, said they are already following the law’s requirements, which largely reinforce extensive guidance put out by state Attorney General Rob Bonta in December.

Community clinics throughout Los Angeles County, which serve over 2 million patients a year, including a large portion of immigrants, have been implementing the attorney general’s guidelines for months, said Louise McCarthy, president and CEO of the Community Clinic Association of Los Angeles County. But she said the law should help ensure uniform standards across health facilities that clinics refer out to and reassure patients that procedures are in place to protect them.

Still, it can’t prevent immigration raids from happening in the broader community, which have made some patients and even health workers afraid to venture outside, McCarthy said. Some incidents have occurred near clinics, including an arrest of a passerby outside a clinic in East Los Angeles, which a security guard caught on video, she said.

“We’ve had clinic staff say, ‘Is it safe for me to go out?’” she said.

At St. John’s Community Health, a network of 24 community health centers and five mobile clinics in South Los Angeles and the Inland Empire, CEO Jim Mangia agreed that the new law can’t prevent all immigration enforcement activity, but he said it does give clinics a tool to push back if agents show up, something his staff has already had to do.

Mangia said St. John’s staff had two encounters with immigration agents over the summer. In one, he said, staff stopped armed officers from entering a gated parking lot at a drug and alcohol recovery center where doctors and nurses were seeing patients at a mobile health clinic.

Another occurred in July, when immigration agents descended upon MacArthur Park on horses and in armored vehicles, in a show of force by the Trump administration. Mangia said masked officers in full tactical gear surrounded a street medicine tent where St. John’s providers were tending to homeless patients, screamed at staff to get out, and pointed a gun at them. The providers were so shaken by the episode, Mangia said, that he had to bring in mental health professionals to help them feel safe going back out on the street.

A DHS spokesperson told CalMatters that in the rare instance where agents enter certain sensitive locations, officers would need “secondary supervisor approval.”

Since then, St. John’s has doubled down on providing support and training to staff and has offered patients afraid to go out the option of home medical visits and grocery deliveries. Patient fears and ICE activity have decreased since the summer, Mangia said, but with DHS planning to hire an additional 10,000 ICE agents, he doubts that will last.

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