Lead Mentor: 
Michael Gusmano, College of Health

2024 Impact Fellows:
Nathan Balderas '27
Ashley Kim '27
Aasser Omar '27
Nikitha Ram '26
Kasey Vanegas '27
Thomas Megan '27

Project Description:
The nation’s 10.5 million undocumented immigrants constitute a “medical underclass” in American society. Apart from their eligibility for emergency Medicaid, undocumented immigrants as a population are ineligible for public health insurance programs, including Medicare, Medicaid, the Child Health Insurance Program (CHIP), and subsidies available to purchase private health insurance under the Patient Protection and Affordable Care Act (ACA), because they are not “lawfully present” in the U.S. Surprisingly little is known about how health care professionals and safety-net organizations serving immigrants cope with federal law and other restrictions on meeting the health care needs of undocumented immigrants when they seek care, and about actual policies on the ground.

This project will study how safety-net health care systems in San Francisco, Houston, and New York City are allocating resources, undertaking local experiments to improve access to health care, and defining their obligations to some of society’s most vulnerable members. We will identify and analyze the formal and informal policies of three of the nation’s largest cities. How is health care to undocumented immigrants actually provided in each of the three cities? Where are the gaps and what are providers’ uncertainties in these systems of care in each city?

In year one, we will 1) draw on census and other local survey data to compare the changing demographic, health and socioeconomic characteristics of each city; 2) conduct a critical review of relevant policies and programs and 3) conduct in-depth interviews with advocates, medical professionals and policy makers in each city. The project will lead to several peer-reviewed journal articles describing and analyzing key findings from each city, and to policy recommendations that may be adopted by other communities across the U.S. The team will prepare reports and briefings for presentation to policy makers in these cities and to organizations such as the National Association of County and City Health Officials, the National Conference of State Legislatures, and the National Governors Association.