JHR 425 - IMMIGRANTS’ ACCESS TO SOCIAL SERVICES | JHR 425

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IMMIGRANTS’ ACCESS TO SOCIAL SERVICES

1. FOUNDATIONS OF UNDOCUMENTED IMMIGRATION

Amnesty for aliens has long history in the United States, which has always been country of

immigrants. For a chance to get better economic opportunities or to escape persecution,

individuals have been immigrating to the US without papers. In the twentieth century, geopolitics

and the actions of the United States in the international relations system predetermined further

waves of the arrival of undocumented migrants. For instance, US involvement in Central

America’s civil wars in the 1980s helped to engender instability and conflict that forced many

Salvadorans, Guatemalans, and Hondurans to flee to the US becoming undocumented

immigrants. Likewise, the North American Free Trade Agreement that came into force in 1994

hurt small farmers and manufacturing industries in Mexico, and workers who were laid off

migrated to other countries in search of employment. Similar to enforcement gaps, the laws

facilitate undocumented immigration, such as in 1986 when Immigration Reform and Control

Act placed penalties on the employers for hiring the immigrants without papers but no provisions

to check on their authenticity. After the establishment in the US, mixed-status families and social

networks continue to engage in undocumented migration through family reunion. At present,

there are more than ten million of these illegals living within the United States. With this

population, the number of individuals who were denied social services became a tool used to

manage unlawful immigration. Most used personal responsibility arguments that “illegal aliens”

overburden public resources as well came to the fore. Yet, there is unclear information regarding

the effectiveness of the restricted services to discourage migration. These restrictions may even

prove costly to the taxpayer where say, denial of primary care results to the poor resorting to

expensive emergency services. From the human rights view, social service restraints are

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antithetical to the principles of human density, social justice, and family integrity. Services also

have positive externalities that include improved learning achievements, health, and productivity

from immigrants. Though there is much more to undocumented immigration, understanding the

roots of the phenomenon in history, economics, and decision-making of the US can help address

heated controversies related to immigrant rights to social services. Reasonable policy weighs the

consequences for the budget against values that protect the essence of the community.

Sustainable answers, however, involve addressing structural drivers in sending countries and

making lawful entrance possible for the innocent, labor-earning individuals.

• Historical context

The timeline of undocumented immigration in the United States is quite vast and intricate. But

the foundation of the nation had not put any restrictions on the immigration, still the late 1800s

saw the rise of nazi and racism which led to the Chinese Exclusion Act of 1882 whereby the

Chinese laborers were barred from immigrating. This laid the foundation for other future

restrictive policies that were to be based on racism and xenophobia, not facts. The 1907

Gentleman’s agreement excluded Japanese laborers from immigrating to the United States. Then

there were literacy tests in 1917 to limit the admission of southern and eastern Europeans

considered racially inferior. The Immigration Act of 1924 then took it a step further through its

policy of extremely low numerical caps that favored immigration from northern and western

Europe. These exclusionary polices paved way for current anti-immigration policies particularly

in Latin Americans. They also describe why, when the immigration reform was first discussed in

1960s, it was about family reunification for European ethnicities rather than about America as a

country of immigrants. The immigration and nationality act of 1965 did away with quotas, and

this resulted in the new wave of Asian and Latin Americans. But they still wanted cheap seasonal

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workers from Mexico and other countries, which encouraged undocumented migration. When

these workers started settling in the United States, their American-born children were denied

social services, or education based on the status of their parents. This led to the emergence of a

sub-class of people who could not assimilate or contribute optimally to the society. In the 1980s,

the Immigration Reform and Control Act offered a kind of amnesty to up to 3 million of the

immigrants to encourage them to come out of hiding. However, it did not establish sufficient

legal channels for the future, which inevitably contributed to the growth of irregular migration.

This pattern continues today, with restrictions and deportations failing to address underlying

causes, global distribution of wealth and poverty, absence of legal immigration opportunities,

need for workers in certain sectors, and relatives. Thus, it became apparent that there are around

10. 5 million unauthorized immigrants currently living in the United States, working and paying

taxes but unable to enjoy fundamental privileges. Any talk of reform in immigration must

consider this history and lay the demands of labor alongside human dignity. The debate raises

ethical issues of who is entitled to be in America and how the society can uphold the principles

of justice.

• Current demographics

It is important to note that different from what was a few decades ago, the demographics of the

undocumented immigrants in the United States are not the same. While in the 1990s

undocumented immigrants were young males mainly from Mexico who came to work in

agriculture and manufacturing for a short period, women and children joined them and the

immigrated to cities and suburbs all over the country. Currently, there are approximately 10. 5

million unauthorized immigrants within the United States, with California as the most popular

state followed by Texas, Florida, New York and Illinois. About 4. 6 million were born in Mexico

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but now the origins are becoming more diverse such as Central America, Asia, the Caribbean,

South America, Middle East, and Africa. More than half have been residing in the United States

for over a decade and have families by having children who are Americans. According to the

research, about 4. 5 million of the K-12 students have at least one undocumented parent. The

undocumented population is young, with a median age of 34 compared to the overall U. S.

median age of 44. About 800,000 people are eligible for the DACA program as they were

smuggled into the US as children and became unauthorized immigrants. Available statistics

suggest that the undocumented immigrants are concentrated in agriculture, construction, hotel

industries, cleaning services, landscaping, and food processing industries and paid less than the

minimum wage and without any employment privileges. The absence of legal right entails a very

limited opportunity for accessing a wide range of public social services with the exception of

emergency health services; despite this, undocumented immigrants pay about 7 billion in taxes

every year using ITINs. With the increase of time and the assimilation of immigrants into the

United States, challenges in access to education, health care, housing, legal services and other

needs that are regulated at the local and state levels remain policy issues on the proper degree of

the eligibility of social services for this population.

• Key terminology

Illegitimate immigration is the immigration of individuals into a country in defiance of the

immigration policies and regulations of that country, and without an appropriate immigration

permit. Terminology in this discourse includes illegals, families with members of different

immigration status, beneficiaries of the Deferred Action for Childhood Arrivals, and cities that

offer sanctuary to immigrants. An undocumented immigrant is an individual who was born in

another country and migrates legally or resides in a foreign country without the proper

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documentation. Most of them arrive legally through the temporary visa, and then remain in the

country beyond the validity of the visa. The four types of mixed families are: Families with

members of different immigration statuses, for example, illegal immigrants and American citizen

children. DACA is an acronym for Deferred Action for Childhood Arrivals – a program signed

by President Obama to provide work and temporary residence permits to certain immigrants who

were brought to the US illegally when they were children. DACA recipients can get limited

privileges such as work authorization and state-issued identification cards in some states.

Sanctuary cities are local jurisdictions with policies restricting cooperation with federal

immigration authorities, including avoiding asking people about their immigration status. These

terms shed light on the intricate relation between the unauthorized immigrants and government

agencies. Author notes that people without legal documents find it difficult to access medical

services, education funding, housing assistance, and other social welfare programs. There are

programs that target only US citizens and some categories of legally present aliens. However,

schools must enroll both legal residents and undocumented students in primary and secondary

education, and all can receive short-term, necessary services such as emergency Medicaid. These

families have tough choices of getting the services they need while potentially putting the

undocumented individuals at risk of being detained or deported. DACA beneficiaries get a

temporary shield against deportation and can obtain some privileges but immigration reform was

at a standstill under Trump policies focused on ending all opportunities for legal status. While

sanctuary cities provide documented immigrant populations more access to certain city services,

they are met with resistance from federal politicians who seek to restrict these services and try to

put better immigration laws into practice across the United States. While discussions over such

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issues as immigration policy shifts help to understand how laws affect actual families with

immunity and services.

• Push and pull factors

Illegal immigration is caused by factors that force the immigrants to leave their countries of

origin and seek refuge in other countries such as United States. Some of the most common push

factors are; economic hardship, poverty, violence, political persecution, natural disasters and

other factors that put a person in a position where he or she cannot easily establish a safe and

successful life in his or her country of origin. Most migrate in search of more employment,

education, health care, and other requirements which may be hard to come by or insufficient in

their home countries. On the same note, more developed countries such as the United States still

attract strong pull factors through perceived or actual opportunities in employment, steady

income, protection, social amenities, and family unity. For instance, agricultural, hospitality,

construction, and other labor-intensive industries in the United States rely on the immigrant

workers to occupy low-wage positions, including those that attract the undocumented immigrants

who may travel to the United States legally but then stay beyond the visa period. Network effects

also exist because as initial diasporas are already set, they provide support by providing financial

assistance, job opportunities, housing, information, etc. for the family and other members of the

community who wish to migrate. Additional pull factors exist in so-called sanctuary jurisdictions

in the United States – cities, counties, and states that restrict cooperation between local law

enforcement agencies and federal immigration officials. It is within such areas that additional

safeguards for the rights and access of the undocumented to health, education, housing, ID and

employment among others can be put in place. Despite the fact that federal welfare benefits are

mostly limited, some state and local social service programs may provide additional assistance.

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For example, California permits low income of unauthorized immigrants to obtain public health

insurance and financial assistance for food, shelter, training, and employment. Most notably,

particularly when there is no federal immigration change on the horizon, state laws and State

courts remain active in creating or limiting opportunities for current and future unauthorized

immigrants. Hence “sanctuary” kind policies also include pull factors arising from the fact that

America has a system of immigration enforcement policies which are of an uncertain legal status

due to the lack of Congressional action.

• Economic impact

On one hand, the undocumented immigrants cost the state a lot of money, but on the other hand,

they also use state resources in order to meet their needs. On one hand, some contend that they

drain social services while on the other hand they do not make a meaningful contribution to the

taxes. About 4. 6 million children born in the United States are living in homes with at least one

undocumented family member. These children are eligible for food stamps and Medicaid, which

collectively cost 2 billion in federal funds in the fiscal year 2019. Further, some of the

undocumented immigrants do not have any insurance cover and if they need treatment, they go

to the emergency services without contributing fully toward the costs and the American

taxpayers is forced to pay the bills. Yet, the undocumented immigrants are also useful in

contributing to the economic development of the economy. They constitute more than five

percent of the total number of workers in the United States, and they take up employment in

sectors that are experiencing a shortage of employees, including farming, construction, tourism,

and other sectors. The industries such as farming are able to offer cheap food for the American

people because their wages are comparatively low. Furthermore, while many of them use forged

social security numbers to work, many of the undocumented immigrants are still required to pay

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payroll taxes. This meant that they contributed billion in payroll taxes in 2010 that they paid, yet

they did not access any of the benefits. It also can enhance the breadth of the consumer base and

the rate of growth for American ventures. Overall, households and individuals with an

undocumented status contribute about 74 billion annually for state and local taxes. Even though

they get some public services for their children, who are citizens of the United States, they are

unable to access most federally-funded programs although they pay taxes every year they are in

the country. This issue also has its merits on both sides of the divide. Illegal immigrants have

both benefits and costs in relation to the economy and the availability of services. Thus, more

research is needed, but most of them suggest that they probably pay more in taxes than they

receive in benefits in the long run. However, the effects are not the same for all the states and the

communities within those states. The total economic consequences are related to the type of

industries they apply, their family statuses, their duration of stay in the USA, and the changes in

the global immigration policies. Greater scrutiny and improved thinking and policymaking are

required to get the most out of them and to reduce the costs.

• Social implications

Illegal immigration has a social importance when it comes to the rights of immigrants to access

social services in the United States. Some of the undocumented immigrants come to the country

for employment and business opportunities and to join their families, fleeing from violence or

persecution. However, their status of being refugees makes them ineligible for proper

documents; this limits them to basic needs such as; health care, education, shelter, and other

basic amenities offered by the government. This poses consequences on health, income, and

social cohesion of immigrant families. Due to limited access to preventative medical services or

health insurance, undocumented immigrants are likely to rely on emergency rooms or

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community health clinics. This overburdens local healthcare systems and raises uncompensated

care expenditures for hospitals that treat high numbers of undocumented individuals. Poor access

also influences the poor health since some diseases can be treated upon diagnosis but lack of

access might lead to their aggravation. Furthermore, mixed eligibility for public benefits under

welfare reform can destabilize families – for instance, when citizen children are eligible for

benefits, but parents are not. This translates to a higher poverty and more food insecure status of

immigrant households. Consequences are also apparent in the K-12 education system. Although

undocumented students are allowed to attend primary and secondary schools in the U. S., there

are financial constraints when it comes to college education. If they cannot get federal aid or in-

state tuition in some of the states, promising undocumented youth may not be able to achieve

their full academic potential or their dream careers. On a more general level, the approach of

denying social services to undocumented immigrants also has implications in terms of social

inclusion and the view of immigrants as a drain on resources. Policies of access thus strengthen a

discourse that the immigrant, an unlawful one at that, only consumes our health, education and

social services without giving back, socially or economically. This fosters resentment and

hampers social integration between the native-born and immigrants. On the other hand, it is has

been found that spending on immigrants’ health, education and training yield a positive

economic payoff, especially as subsequent generations assimilate and become productive tax

payers. Fairer social policies could foster integration and relationships between people.

2. LEGAL FRAMEWORK AND POLICY LANDSCAPE

The issue of access to social services by undocumented immigrants has significant legal and

policy implications in the United States. For instance, in the federal level, provisions of laws

such as PRWORA in 1996 limited many health, cash, food, and housing assistance programs for

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the undocumented immigrants. Nevertheless, the PRWORA also allowed states to decide about

the eligibility requirements for the state funded programs. Thus, it is important to note that there

is a wide range of variation regarding policies granting social services access to undocumented

immigrants across states. For example, California, New York, and Washington allow

undocumented immigrants to use state only funds to be eligible for health insurance and cash

assistance programs. However, other states such as Alabama and Arizona have gone a notch

higher in passing laws that would limit access to abortion even more than the federal laws.

Speaking of education access in particular, the Supreme Court’s decision in Plyler v Doe holds

that states cannot legally bar children from enrolling in K-12 public schools based on their

immigration status. Nevertheless, the policy on postsecondary education is still different. Certain

states allow students who meet DACA eligibility to pay in-state tuition at public institutions of

higher learning, while others have a policy against it. In addition to policy barriers, even the

legally protected beneficiaries of this demographic cannot receive services because they are not

aware of their rights, or afraid of interacting with government workers, or the lack of language

translation services, or the unwillingness to enroll family members who are not eligible for

immigration status. Adding to these developments, needs have escalated due to the COVID-19

pandemic while new barriers have emerged. Legality of health care from programs invented for

COVID-19 diagnosis and treatment has raised questions on the undocumented immigrants’

access and as a result, discouraged them from seeking medical care. For this group of people,

required service will remain targeted outreach and policy guidance in the context of the

pandemic to be able to use health care services and receive financial support. In general, the

situation remains rather equivocal. Policies are always changing and unpredictable at the federal,

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state, as well as at the local levels. The access to social services by undocumented people living

in the United States still needs more advocacy and research in order to introduce parity.

• Federal immigration laws

Undocumented immigrants’ access to social services is heavily regulated by law and it is a

subject of a great legal controversy. At federal level there is the Personal Responsibility and

Work Opportunity Reconciliation Act of 1996 (PRWORA) which makes it unlawful for state or

any federal agency to provide means tested public federal benefits to the undocumented

immigrants. However, PRWORA does not prohibit states from offering state-funded services to

the undocumented. Therefore, the accessibility of social services is very much diverse from one

state to another. For instance, California recently voted to extend Medicaid eligibility to

noncitizens under the age of 26. On the other hand, other states such as, Alabama have

implemented strict verification conditions for the purpose of restricting entry. The Illegal

Immigration Reform and Immigrant Responsibility Act of 1996 (IIRIRA) also affects the access

because it prohibits the unauthorized immigrants from being issued with a driver’s license or a

state identification card if such an ID is considered in the determination of the eligibility for the

public benefits. However, some states issue other driving documents that are not acceptable for

federal identification. On the enforcement side, measures like 287(g) partnerships between

Immigration and Customs Enforcement (ICE) and local law enforcement agencies have been

accused of creating despair and restricting the use of social services among immigrants.

Sanctuary cities seek to build trust by reducing coordination with federal immigration officials.

But the extent to which they can offer meaningful protection has been hampered by threats by

the federal government to defund the CBOs. Moving forward, the Biden administration favors

increasing the coverage of health insurance to the immigrants. However, major reforms would

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herald legislative action from a congress that is currently sharply divided. Therefore, the current

legal status of the undocumented immigrants and social services still remain ambiguous and

questionable owing to the existing tension in perception of the people, opposition from the

various stakeholders, limited funds, devolution of power in immigration policies to the state and

the vast effects of any change in the federal immigration policy.

• State and local policies

There are significant differences in state and local policies on eligibility for social services for

undocumented immigrants in the US. Despite the existence of some federal standards, state and

local officials have relatively broad discretion in determining eligibility, the kinds of services

offered and even how often immigrants must report to federal authorities. This fundamental

dichotomy is between the states and localities that seek to incorporate the illegal immigrants in

society and those that aim at deterring unlawful immigration. On the progressive side, some

states and cities have gone to the extreme with some of the measures they have implemented. For

example, California grants the undocumented immigrants the right to health insurance subsidies,

disability insurance benefits, and state financial aid for college. New York City is implementing

programs for accessing health care, nutrition assistance, education, and workforce development

for the undocumented people. Such places justify extension of services due to undocumented

immigrants’ economic and social contribution in the local area – paying over billions of dollars

in taxes, participating in volunteer organizations and churches, and having strong roots in the

communities that have kept them for decades. While some state and local governments have

less-stringent laws and policies, others have different stances on whether undocumented

immigrants should receive public benefits. Certain states require government employees to

disclose immigration status when persons seek public benefits. Some other states do not allow

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undocumented students to enroll in public colleges at the rates that are applicable for residents of

their respective states. At the local level, attempts are made to dissuade unlawful migration

through restriction of rights to housing, employment, banking services or ID cards to the illegals.

such measures are justified as a means through which future waves of unauthorized migrants

would be deterred considering the fiscal costs and increased complaints on immigration that are

outside legal channels. Controversies exist over the normative foundation and empirical

consequences of inclusive or exclusionary social welfare policies towards the undocumented

immigrants at state and local arenas. But the very fact that states and cities can adopt such

radically different policies stems from the legal framework – a system that effectively devolves a

great deal of immigration and welfare policy discretion to subnational actors. While at the

national level the immigration policy reforms always remained stuck in political debates, state,

and local authorities become the frontline that sets dramatically different inclusion versus

exclusion realities for undocumented people across the country.

• Sanctuary cities

Sanctuary cities are localities within the United States that have implemented measures or

ordinances that restrict the interaction between local law enforcement agencies and federal

immigration agencies. Sanctuary cities are connected with the idea of giving the possibility to the

unauthorized individuals living in cities to use the city’s resources and services without worrying

about deportation. To this day, there is no clear legal definition of what a sanctuary jurisdiction is

and how local authorities and agencies interact with federal immigration authorities. Some of the

differences between sanctuary city policies involve the extent to which city workers are

permitted to ask about the immigration status of a person they are in the process of serving, the

level of cooperation that local police offer to federal immigration agencies in areas such as

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detainers, and the extent to which the city can work towards achieving the goals of the federal

immigration enforcement. Critics assert that sanctuary city policies promote the illegality of

immigration while supporters say that such policies enable the undocumented people to obtain

essential needs, report criminal activities, and engage with law enforcement agencies without the

threat of deportation. Essentially, under the law, a significant federal appeals court ruling handed

down in 2017, namely Chicago v. Sessions, holds that the federal government cannot impose

new conditions on grant funds that were already allocated by Congress to penalize the sanctuary

cities. Finally, it is important to address the future of sanctuary cities and the policies

surrounding them as still unclear and ambiguous. The current administration remains active in

looking for ways to reduce funding and escalate legal action against sanctuary city policies. At

the same time, the number of sanctuary jurisdictions increases throughout the USA. In

conclusion, sanctuary city policies lie in the rather fragile and contentious area of federal

immigration law on one hand and the Tenth Amendment of the Constitution, which reserves to

the states and local governments the power to decide how the local resources and funds are spent

and to what end on the other. It appears that the conflict between the current administration and

the sanctuary cities will not fade away in the near future. Since immigrant populations are

heavily located in urban areas, the sanctuary policies have social implications that touch on

various services including medical, education, and policing. As this exacting contest between

national and local agendas on immigration enforcement is played out, the stakes for

undocumented people and communities in terms of their capacity to avail themselves of benefits

and services without risking deportation become significant.

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• Immigration enforcement priorities

The strategy of enforcing immigration laws has from time to time changed with regard to the

presidency in office and the political climate on immigration. Immigration raids during the early

2000s under the Bush administration targeted aliens that were deemed to have criminal records

or are a security threat to the country. However, deportations broadened to embrace anybody

regardless of their immigration status who violated the laws including traffic offenses. Some

changes of the Obama’s administration were launched in 2015 due to the organization of the

Priority Enforcement Program which was oriented to deport immigrants with dangerous crimes.

This was meant to foster confidence of the immigrant community in the local police forces and

focus on threats to security. The Trump administration took a hardline approach to immigration

policy by increasing the number of categories of undocumented immigrants that could be

deported. Policies shifted to target those with a final order of removal and those who committed

any criminal offense or abuse of public benefits. The consequence was the overall increase of

fear and insecurity among immigrants. The Biden administration has sought to go back to

targeting immigrants who pose risks to public safety and national security. However, the effects

of recent political oscillation on the priorities of enforcement are still felt today by the

undocumented immigrants in their lack of willingness to seek for health, nutrition, education etc.

for the fear that it will result in adverse immigration consequence. Finally, shifting goals for the

conduct of immigration enforcement impacts the most sensitive communities – mixed status

families with children, victims, patients, and disaster-struck individuals. The legal system needs

to be more considerate, understanding, and coherent in its application in order for immigrant

families to seek basic needs and not be threatened with deportation or being separated from their

loved ones. It is still a delicate process to set up appropriate enforcement priorities and at the

same time provide individuals with easy access to social services.

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• Legal rights of undocumented immigrants

Illegal aliens living in the United States are in a vulnerable legal status and they receive very

limited social services. Even though federal policies limit the access of public benefits, states and

localities have certain degree of decision making in the matter. Several constitutional laws

explain the rights of the undocumented immigrant children regarding their right to K-12 public

education based on the Plyler v. Doe Supreme Court Case of 1982. However, access to post-

secondary education continues to be limited under federal law with only a few state waivers

allowed. Similarly, eligibility requirements involving documentation also influence the limited

options available to the undocumented immigrants in terms of the health, nutritional, as well as

income support services. For example, federal legislation prohibits most of the undocumented

immigrants from accessing Medicaid, CHIP, SNAP and TANF, with the exception that states can

cover some categories using their own funds. Furthermore, federal privacy laws restrict the

reporting of information between the benefit providers and immigration authorities. Aside from

social services, many of the undocumented immigrants have limited opportunities for obtaining

legal status. Approximately 10. 5 million undocumented immigrants were living in the United

States in the year 2017. While some of them can seek relief like asylum or family based

immigration, the majority experience rigid quotas and multi-year wait lists before possibly

attaining status. Measures of enforcement and borders security have also grown over the decades

mainly through legislations and executive orders by various presidents from both political

parties. For instance, Secure Communities and 287(g) agreements enable partnership between

local and federal governments in immigration enforcement. Similarly, the extent of worksite

enforcement actions increased in the 2000s-2010s. Increasing deportations coupled with

restricted access to legal opportunities continue to cultivate fear and instability for many

undocumented immigrant families desiring social networks and legal citizenship.

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• Policy reform debates

Current policy changes concerning the use of social services by the undocumented immigrants

remain a contentious issue today. Critics claim that the current limitations are inhuman because

they deprive the susceptible populace essential commodities. For instance, over 4 million

children that are undocumented cannot be enrolled in food assistance programs despite the

prevailing poverty levels. Critics point out that the consequences of service denials are also

detrimental to communities as health and nutrition needs are not met, causing more health

problems and poor academic performance in school. There is also evidence that restrictive social

welfare policies do not discourage unauthorized migration but instead exacerbate immigrants’

social and economic exclusion. Opponents, on the other hand, say that extending the referenced

benefits leads to more people crossing the border illegally, as well as the drain on the exchequer.

Opponents have argued that, social services should be given only to the citizens who have

contributed taxes in the support of such services. Some take it a step further and advocate for the

repeal of birthright citizenship protections, which as it stands grants citizenship to any child born

in the United States regardless of their parents’ immigration status. However, when such changes

are implemented, serious legal questions appear as to whether it infringes on the Constitution and

international human rights conventions. All things considered, there are intricate balances at

stake with respect to resource equity, human rights, public health concerns and immigration

enforcement outcomes embedded in policy options on this subject. Such arguments are often

disregarded by the extreme views of either side of the conflict. For example, denying millions of

resident immigrant children the right to education and health care threatens to create a lost

generation. On the other hand, offering extensive benefits without immigration reform could

encourage the influx of illegals. Therefore, mid-level policies that include limited entitlement to

some social services and an overhaul of the immigration laws to allow long-term undocumented

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residents a chance at citizenship make good politics. However, enacting relatively complex

immigration policies with bipartisan support has remained a herculean task in the federal set up

while the public remains supportive of moderate policies. As a result, not much policy activity

has happened at the federal level in recent years, resulting in significant policy variances

between states and localities. The failure to achieve comprehensive reforms that address the

different policy equities is still a challenge as can be seen in the current stalemate at the federal

level.

3. HEALTHCARE ACCESS AND CHALLENGES

Unauthorized immigrants encounter significant hurdles and obstacles in their attempts to obtain

healthcare in the United States. Undocumented immigrants have limited access to health care

because they cannot receive Medicaid or purchase health insurance premiums. Unfortunately,

this means that most of the undocumented immigrants receive their health care in the emergency

rooms or other community health facilities, which can only attend to them when the minor health

complications have escalated to become major ones. It was established that uninsured immigrant

adults without documentation access are more than three times the number of documented U. S.

citizens in a regular source of healthcare. The issues that many undocumented immigrants

experience include language differences, unfamiliarity with Western medical systems, fear of

deportation, and complicated bureaucratic processes when seeking care. Some policies are still

ambiguous about their stand on serving uninsured patients and dealing with the immigration

enforcement agencies. Each of these complexities helps create significantly limited health care

access for undocumented immigrant families and communities. However, for the undocumented

children, choices were slightly enhanced after the 1982 Supreme Court decision, Plyler v. Doe

that declared that states cannot bar children from attending K-12 education due to their

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immigration status. This paved way to school-based social services and health programs for

undocumented students. The DACA program also now shields many undocumented youth and

young adults from deportation, which fosters engagement in assistance programs. Nevertheless,

undocumented parents continue facing challenges in getting insurance for their families or

qualifying for the necessary criteria for obtaining subsidized coverage for their children. Still,

some cannot buy insurance through employer sponsored plans, AHCA exchanges, Medicaid,

CHIP, or Medicare plans. Other legal challenges have also been experienced by the States in

their attempts to expand health coverage for the immigrants. This puts many undocumented

immigrant families in a challenging position of being unable to afford or access the healthcare

they require, which has implications for the overall health of the community in the long run. The

key barriers of eligibility, cost, language/cultural difference, fear, and administrative complexity

must be overcome to provide adequate healthcare to this vulnerable group.

• Emergency medical services

The emergency health care facilities in the United States are very closed to the undocumented

immigrants. While there is federal legislation that requires hospitals to provide care and stabilize

patients regardless of their immigration status or ability to pay, many undocumented people are

still unaware and thus, they avoid seeking medical attention due to fear of being deported or

being left with enormous bills. Patients who present to emergency departments may neglect

some information about their past medical history or requirements for follow-up care for some of

the same reasons. These challenges are further compounded by language barriers for the

undocumented population in seeking emergency care. Interpretation services and Spanish-

speaking staff are often inadequate in providing support to hospitals. Therefore, immigrant

patients have poor comprehension of their diagnoses, treatment plans, discharge instructions, and

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prescription details. Additionally, lack of knowledge and understanding of western concepts and

healthcare practices could create confusion over when to seek for an emergency service instead

of a primary or a specialist care. Hence, the undocumented immigrants usually depend on the

emergency departments as their primary care despite having inadequate health literacy to engage

in decisions about their treatment. These restrictions to emergency medical necessity have

negative effects regarding health. Delay in presenting to a health facility when they experience

severe conditions such as heart attacks, strokes and injuries may lead to unnecessary

complications. Preventive care services are another area where undocumented immigrants are

also not very well taken care of and chronic diseases are poorly managed hence, they attend

emergency services with exacerbations that could otherwise be prevented. Furthermore, the

frequent reliance on emergency departments instead of primary care hinders the delivery of

coordinated and integrated care. Therefore, although the federal law mandates equal treatment in

emergency situations, further steps are required to achieve a higher level of equality in the

provision of healthcare as a means of improving the health of immigrants in the long run.

• Preventive care barriers

There are many preventive care challenges that affect the health of undocumented immigrants.

One major challenge is the lack of adequate health insurance since the undocumented

immigrants cannot qualify for Medicaid, Medicare, or ACA marketplace subsidies. They are

forced to use emergency Medicaid or to independently pay for the services, and, as a rule,

preventive care is not an emergency. Also, it can be considered that undocumented immigrants

can be afraid of deportation if they turn to medical services, especially if personal data is

collected in the process. These concerns have been fueled by recent changes in the public charge

rule even though healthcare and food assistance are excluded, given the ease with which

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misinformation circulates in immigrant populations. People could be afraid of going to clinics or

hospitals because it might make the authorities aware of their presence or their immigration

status. Language barriers also affect the availability of preventive care since some people are not

fluent in English. Transcription services may be available in limited or not at all based on the

medical center. Preventive care norms of the immigrants’ country of origin can also be an issue

as it may act as a barrier towards accessing care. Some procedures like pap smears,

mammograms, colonoscopies, and mental health evaluations are stigmatized or appear novel and

lead to neglect. Lack of insurance also negates preventive efforts since small copayments and

health expenses add up very fast in case of financial insecurity. They are most likely to be

employed in low wage work without health benefits, paid sick days or leave, and flexible work

schedules which complicate preventive medical appointments. They may be afraid of missing out

on pay or even losing their jobs when they are away. Time constraints also pose a challenge,

especially when travelling to areas that are served by limited and inadequate transportation

systems. The combined effect significantly reduces the number of preventive consultations,

screenings, medications, immunizations, check-ups, and counseling that are accessible to

document immigrants in contrast with citizens with health insurance coverage and workplace

accommodation. In the long run, lack of access to preventive services results in conditions that

could otherwise have been prevented, increased utilization of emergency services, difficulties in

chronic illness management, and overall poorer health. It also escalates the threat of diseases to

the public and the load on the healthcare services. Prevention is a factor that has a negative effect

on individuals and groups of immigrants with aspects such as finances, workforce involvement

and efficiency, families, mental health, and the overall quality of life. While federal or state level

insurance and public charge expansions do not seem probable at the moment, local efforts to

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raise awareness about healthcare access, provide funding for clinics that offer free or low-cost

preventive visits regardless of immigration status, create multilingual health campaigns, and

support transportation vouchers could potentially reduce preventive care disparities for

undocumented immigrants.

• Public health implications

These cut-off points present severe threats to the immigrant community’s health needs as well as

other people’s health needs across the United States because most of the undocumented

immigrants receive inadequate medical attention, and social services. Many of the undocumented

immigrants avoid getting medical care due to the cost and the possible effect of deportation. This

is because the undocumented immigrants cannot afford preventative care hence they develop

complications and get early diagnosis hence worsening their health condition and succumbing to

more severe diseases. Diabetes, hypertension, and cancer remain untreated or often diagnosed at

a late stage, increasing the vulnerability of undocumented immigrants to medical complications.

At the same time, the rate of the spread of communicable diseases also increases in the

undocumented community without adequate access to medical facilities and treatment. Studies

indicate a significantly higher prevalence of tuberculosis, hepatitis, HIV and other sexually

transmitted diseases among the undocumented immigrants than other Americans as the negative

health outcome worsens in the absence of any intervention. In addition to the wellbeing of

undocumented people, the impact on wider public health continues to be substantial. Epidemics

that can be prevented of communicable diseases that start from undocumented populations still

affect legal residents and citizens through moving to legal residents’ communities, school

systems, workplaces and public places. In a practical perspective of public health policy, limiting

access and availability of medical care to such populations in fact negatively impacts other

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general goals of disease prevention and population health management. Cohort inequities

regarding race, ethnicity, and SES in healthcare that are apparent in the case of undocumented

immigrants defy broader policy aims for health equity within all population subgroups. Policy

changes that provide care and coverage to the undocumented immigrants would enhance their

health status and disease prevention in the undocumented groups and lawfully in the legal

resident groups. Inextricably linking the necessity of reforming affordable and accessible

healthcare to public health, it is necessary to call for including undocumented immigrants into

the planning of local, state and national public health policy.

• Mental health considerations

Many of the documented challenges explain why the undocumented immigrants in the United

States have limited access to mental health care services and support. Undocumented immigrants

have come to the United States to escape situations that include violence or trauma, suffered

trauma during the migration process, and live in the United States in constant fear of detention or

deportation Mental health disorders that are common among undocumented immigrant

populations include depression, anxiety, and PTSD. However, most of the undocumented

immigrants do not have health insurance coverage that would enable them to access mental

health care. Although there are state-level policies that allow undocumented immigrants to

purchase health insurance through the ACA marketplaces, even in states that offer coverage

regardless of immigration status, enrolment remains low due to factors such as cost, limited

awareness, and concerns about sharing personal information. Nonprofit and community health

centers try to address the shortages, but their capabilities do not suffice for the massive numbers

of undocumented individuals in various states. Other obstacles include language barriers, lack of

culturally appropriate care, and concerns over immigration officials gaining access to their

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medical records. Mental health care involves patients sharing personal information with their

doctor about trauma, depression, substance abuse and the like but undocumented immigrants

reasonably assume that this information can be used against them in immigration courts.

Providers also lack adequate knowledge and understanding of the various cultural beliefs

regarding mental health. Thus, even when services are available to them, the undocumented

immigrants demonstrate less trust and desire to seek assistance. Unfortunately, such mental

health conditions when not treated aggravate the chances of encountering a police incidence due

to inadequate training, leading to detention or deportation. To enhance health care access and

quality of mental health services for undocumented immigrants, strategies that focus on cost,

privacy protection, culture-specific training, targeted marketing for vulnerable populations, and

separation of health care services from immigration enforcement agencies are essential.

Promoting the mental health and psychological well-being of diverse people enhances the public

health good. Nevertheless, there are still various intricate questions left: how to guarantee the

accessibility of services and at the same time, build trust in the provider-patient relationship, and

how to safeguard the recipients from systems that allow immigration violations perceived as

such to trump humanitarian obligations.

• Healthcare for undocumented children

A number of challenges exist when it comes to availing healthcare to undocumented immigrant

children in the United States. Even if undocumented children can access emergency Medicaid,

they cannot access other forms of Medicaid as well as other public health insurance programs

including the CHIP. This puts undocumented families in a position where they have to bear the

full cost of any healthcare that their children may require other than emergencies, which is costly.

A single investigation revealed that whereas 97% of citizen children are insured, 63% of the

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undocumented immigrants’ children are insured and this was through private purchase.

Nevertheless, working-class undocumented parents continue to face significant challenges in

access to affordable private unsubsidized coverage. Due to low earnings and poor health cover,

most of the undocumented parents cannot afford the recurring premiums, co-payments and even

deductibles associated with private health insurance. This financial obstacle to healthcare

contributes to many undocumented parents avoiding or putting off health care for their ill

children. Studies have also identified the carry-over impact on the citizen children because

parents may also stay away from programs such as WIC, SNAP due to ambiguity over the rules.

In total, these access problems disproportionately put undocumented children at risk for an array

of adverse health outcomes, from lower rates of preventive care to the exacerbation of acute

conditions into chronic ones. Heath policy scholars have claimed that the absence of accessible

and affordable healthcare for this category contradicts the ethical principles of modern

democracies. Some states have sought to implement policy reforms that are patchwork in nature,

including efforts to increase access to prenatal care for undocumented mothers because it makes

fiscal sense and is good for citizen children. Nevertheless, broader strategies to fundamentally

shift the nature of the problem are still yet to be fully realized politically across large parts of the

nation. Currently, more than 4 million children living in the United States are undocumented, and

their absence from healthy policy debates is problematic.

• Community health initiatives

Many barriers hinder the ability of undocumented immigrants to seek healthcare in the United

States including the fear of deportation, lack of insurance, and language barriers. Through

outreach, education, enabling services and medical services, community health initiatives aim at

improving healthcare access and usage among this group. For instance, migrant health centers

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are federally funded to deliver primary, dental, mental, and other health services to MSAWs

irrespective of their immigration status and affluence. They address barriers by employing

workers who speak the affected language, providing interpretation services, facilitating

transportation and translating services for enrolling in emergency Medicaid for those seeking

emergency care. Faith-based initiatives also have health fairs where they offer simple health

checks on blood pressure, blood sugar levels and body mass index. They refer patients to the

safety net clinics for follow up treatment in case the tests results show abnormality. Some even

have volunteer doctors and nurses occasionally organize free clinics for basic emergency

treatments. Cultural brokers create alliances through existing social networks thus alleviating

concerns of deportation that may result from seeking health services. While the undocumented

immigrants are insured at a very low percentage, they depend on emergency services, which are

mostly episodic in nature rather than longitudinal and preventive in the case of chronic diseases.

Community programs focus on enhancing health literacy and proper utilization of health services

by health education outreach involving youth groups, congregations, English classes and other

social established groups providing information regarding prevention and management of

common conditions such as diabetes, hypertension and obesity. Pilots funded through grants are

able to enroll undocumented pregnant females into prenatal care coordination programs

enhancing maternal and fetal health while decreasing the associated costs of neonatal intensive

care due to complications. Inability to afford these things forces immigrant families to seek

something like buying medications in Mexico without prescriptions or even doctors. It has access

by having the Spanish speaking clinic staff who organize volunteers to accompany groups of

patients across the borders to get the approved lists of medications such as insulin or inhalers to

have better control of the medications, thereby reducing risks. Other ‘buyers clubs’ do the same

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to acquire hepatitis C treatments, globally, at cheaper prices to overcome the hurdles involved in

accessing curative specialty medicines. Achieving health care access is a multifaceted issue that

involves overcoming such hurdles as fear, language, cultural differences, cost, and patient-doctor

trust. Community health initiatives employ connections and providers from the marginalized

communities themselves to bridge the barriers to healthcare.

4. EDUCATION RIGHTS AND OPPORTUNITIES

Education is a basic human right that is undeniably supposed to be enjoyed by everybody

including immigrants. But the undocumented immigrant students encounter many challenges that

hinder them from obtaining education in the United States. According to the legal ruling in Plyler

v. Doe case of the supreme court in the United States of America in 1982, it is unlawful for the

states to deny children a basic education in K-12 on the basis of their illegal immigration status;

however undocumented students have continued to drop out of high school and lack access to

college. Despite the provisions of the Plyler v. Doe, undocumented children are vulnerable to

acts of bullying, discrimination and unfair enrollment that hinders their education. Many of these

students encounter financial problems due to their inability to secure jobs, language barriers for

non-English speaking individuals, and absence of counseling services all affect the academic

performance and continuation rates among the undocumented students. However, once these

students complete high school, they are unable to access public funds for their college tuition and

are charged out of state tuition making college education seem out of reach. Since there is no

legal way for many of them to obtain legal status or citizenship under the current law, the

education being offered as a means of economic stability and prosperity becomes a mere facade.

Granting greater education rights and opportunities for undocumented students would bring

economic and social benefits for communities and localities across the United States. Pursuit of

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and completion of post-secondary education results in improved wages, lower rates of

unemployment and poverty, and decreased reliance on the welfare system. The expansion of

opportunities to extend education to undocumented students benefits diversity and equal access

to education as well. To that end, some states have acted to expand access and affordability –

more than 20 now permit undocumented students who meet the relevant criteria to pay resident

tuition at public colleges. A federal DREAM Act will go even further to offer those willing to

pursue military service or college education a chance at citizenship. Nevertheless, similar

policies have remained politically sensitive due to ongoing disagreements on immigration

legislation in the Congress. In other words, today’s undocumented students are afforded the right

to basic education within primary and secondary institutions but remain restricted from achieving

educational success and postsecondary education. The attainment of educational rights and the

extension of educational opportunities have individual and societal economic and social returns.

However, such reforms could only be achieved by transforming political discourses on

immigration and citizenship to embrace education as a fundamental human right.

• K-12 education access

It is important to note that the K-12 education for undocumented immigrant children is a

challenge. Despite the Plyler v. Doe ruling stating that the states cannot unconstitutionally bar the

students from accessing free public K- 12 education on grounds of immigration status, issues

concerning enrollment still prevail. Most of the school districts are implementing barriers that

prevent kids from enrolling if they have no Social Security numbers or documents that their

parents cannot produce because of immigration status. This is in direct violation of the Plyler v.

Doe decision that seeks to hold that access to education is fundamental in realizing the potential

of a person and to become useful members of the society despite their immigration status. In

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addition to enrollment issues, students who are undocumented face challenges in remaining in

school and getting the support services that are required for them to do well in school. They drop

out, fail, and are retained at higher rates due to factors such as poverty, trauma, low parent

education levels, and language barriers that schools do not account for. Teachers and staff might

also not know how to address vulnerable, immigrant/refugee learners. For instance, districts do

not deliver adequate English Learner programming that is necessary for gaining academic

competencies. Lack of college/career counselling for undocumented students also reduces future

opportunities and participation in completing high school. Consequently, despite the banned

exclusion of free K-12 education on the grounds of immigration status, undocumented students

do not receive equitable and supportive access in public schools in practice. Critics say that

Plyler v. Doe defined a minimum level but more should be done to ensure that immigrant

students are allowed to exercise their legal right to education from enrollment to graduation

without regard to their legal status. In order to strive academically, students need all the

necessary resources and instruments which are provided to the documented students. It is a

fulfillment of education rights and schools to engage needs of undocumented pupils who are

immigrants to prevent individual development, community value of talents, and violation of the

constitution. As the Supreme Court noted, equitable access provides kids with the chance to

become responsible and contributing members and this is where society benefits in the future

through the generations produced through the public education system.

• Higher education challenges

The authors mention that there are many challenges that undocumented students experience

while pursuing postsecondary education. This financial challenge is a major barrier as according

to the federal laws, the immigrants who are undocumented cannot access federal funds, loans,

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grants or scholarship. Holding no job opportunities for lack of proper immigration papers, most

undocumented students are financially straining themselves to meet raising university tuition and

fees. This also affects the retention of students and the graduation rates of the students within the

institutions. Undocumented students pay for their educations on their own, mostly through part-

time jobs, private scholarships and financial assistance from non-profit organization – and these

sources are scarce compared to the demand. This financial pressure can also affect the

acquisition of books, laptops, and other educational requisites that documented students with

financial assistance may assume. In addition to fiscal challenges, documented students have cited

social exclusion because of documented students attributing the secrecy and shame that their

undocumented counterparts have to their immigration status. Undocumented students also have

concerns that engaging in campus life activities may put them or their families at the risk of

being deported. Depression, anxiety, and post-traumatic stresses are not exceptional since

undocumented students deal with acute stresses in their day to day lives. For this reason,

undocumented graduates also encounter extremely limited job opportunities due to their

immigration status despite having completed their degrees and the personal cost incurred.

Licenses or certifications that are mandatory in various professions are often unavailable to the

undocumented. Fear of long-term economic instability and even joblessness permanently

influences the career goals and field of study of the undocumented students. However, a degree

has tended to be a long-term asset, and thus even the undocumented can benefit from it. In

conclusion, undocumented students face challenges in every aspect of financing, becoming

active members of the campus, and utilizing their degrees upon graduating. Some colleges and

non-profit groups have developed support programs to help undocumented students deal with

archaic laws. However, there is a need for more legislative reforms at the federal and state level

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to reduce the existing disparities to near parity in order to match the words that are being used

where people are told that they want equal access to educational opportunities.

• DREAM Act and DACA

DREAM: Development, Relief, and Education for Alien Minors is a piece of legislation that has

been proposed to be passed in congress in different forms since 2001, although it has not passed

both houses. The laws would offer a legal status to qualified young immigrants if they want to

complete high school, attend college or join the military. The common requirements are that the

person must have arrived in the USA at the age of no more than 16 and has resided in it for

several years without interruption. The students who are given relief through the DREAM Act

could then have an opportunity to receive tuition for higher education, and work permission.

While both the Democrats and the Republicans in Congress support it, partisan politics have

prevented the passage of the DREAM Act for more than 15 years now. But failure to enact a

stringent federal immigration reform paved way for the enactment of DACA in 2012. DACA is

an action that offers work permits and shielding from deportation to undocumented young

immigrants who arrived in the United States as children through the merits of DREAM Act.

DACA beneficiaries can apply for driver’s license and social security numbers through which

they can enroll in colleges, acquire legal and valid work permits, apply for bank accounts, and

engage in other activities in the society. Approximately 1. 8 million of them are children who

arrived in the United States and can be eligible for the DREAM Act or DACA. About 98,000

undocumented students graduate from high school every year and while they are qualified to

apply for the federal financial aid, they cannot do so. Making education and status for young

undocumented immigrants who were brought up in the US available is both an issue and relevant

in reform that affects millions of people in local communities in America.

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• Language barriers

This is a major challenge given the language disparities that the undocumented immigrant

students and families experience when trying to access education rights and opportunities. It is

also important to note that a significant number of the undocumented immigrants especially

those who arrived later have low English-speaking ability. This can significantly impair their

capacity to comprehend information concerning enrollment in schools, academic standards and

expectations, programs and services, financing for education and colleges, among others. The

low English-speaking abilities mean that the parents cannot effectively communicate with the

teachers and administrators, support their children, and help with homework. This language

barrier hinders educational opportunities and achievements. But of course, for the undocumented

students whose English is still being honed, getting academic work becomes even that much

tougher. Language proficiency is essential when comprehending what has been taught in class,

reading text books, writing essays, doing tests, and understanding mathematical word problems.

The students are left far behind in their grades even though they possess the intellectual capacity

to learn more, due to lack of appropriate language acquisition experiences. They need more help

with literacy development, needing tutors, and modifications on assignments and evaluations. If

not provided because of resource constrains, achievement gaps persist or even increase. Lacking

self-esteem and expecting to encounter negative attitudes from native English-speaking

counterparts, struggling ELLs may also avoid class participation or engaging in other co-

curricular or extra-co-curricular activities or questions, which would serve to inhibit their

acculturation or development even more. Adding to these concerns, information regarding many

social services and programs to support those students who are struggling academically is still

mostly in English only. Those with undocumented statuses cannot maneuver through the online

resources or understand written provisions of eligibility and therefore cannot access necessary

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assistance. However, bilingual outreach coordinators and community liaisons, who could explain

the policies and procedures in the other languages, are scarce because of the lack of funding.

Thus, education language policies and programs create barriers in the K- 12 pipeline for the

undocumented immigrant families. Meeting English learners’ needs and expanding multilingual

access to academic help resources could greatly enhance education equity in the long run.

• Cultural integration in schools

It is, therefore, imperative that schools address the cultural assimilation of undocumented

immigrant students’ and their families. Since young people devote a considerable amount of time

in their developmental stage in school, the school environment plays a crucial role in influencing

their identity, community and citizenship. On the downside, the integration of undocumented

students may be hampered by issues like discrimination, bullying, lack of funds, and no access to

support. Some ways in which schools can facilitate integration include encouraging students

from different cultures to be friends, teaching languages, and respecting and implementing

different cultural practices, offering scholarships, sensitization of teachers and staff on

immigrants and their rights, and ensuring that every student, regardless of his/her origin, receives

equal opportunities in class/academic and co-curricular activities. This is particularly having

regards to English Learner (EL) programs which facilitates learning of the language for non-

native students as well as teaching them content. Dual language programs enable native and non

native English speaking students to learn at the same group, thus enhancing cultural interchange.

It was found that schools can help with the paperwork involved in enrolment, which may be a

problem for those with language issues or no papers. Offering mental health in their own

languages can assist to alleviate trauma resulting from immigration. It is also important to note

that schools can have flexibilities on customs such as wearing of religious fabric or performance

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of certain cultural beliefs and practices. Ethnic clubs, sports, music, drama, and multicultural

activities such as ethnic weeks and days give students an opportunity to practice their cultures

and embrace the similarities. Finally, cultural integration in schools allows the undocumented

students to feel that they are part of a community without being isolated. This has positive

implications on academic performance, peer relations and general student health. It also enables

all the students to have intercultural disposition that will be very useful as the world becomes a

global village. Thus, with effective policies and practice, schools can promote the integration of

immigrant communities rather than exclusion, and produce engaged citizens even when they are

undocumented youth. The importance of investment more within the integration within school

system to better the lives of the community and the nation.

• Educator responsibilities