Association for Public Policy Analysis & Management

Undocumented immigrants detained by the U.S. Immigration and Customs Enforcement Agency (ICE) are a particularly vulnerable population because of the mentally, physically, and medically-straining conditions they endure as they immigrate to the U.S. These conditions are intensified and worsened if they take up residency in the U.S. because of restricted access to healthcare and other health services, which can be exacerbated by failure to seek care due to fear of being deported. When undocumented immigrants are apprehended and detained by ICE, the detention facility is responsible for the humane treatment and medical well-being of undocumented immigrants.

Health services in all ICE-affiliated facilities are supervised by the ICE Health Services Corps (IHSC). Under this system, healthcare is provided through one of three approaches: directly by IHSC staff, through contracts with state and local governments, and through contracts with private medical service providers. While the IHSC is only responsible for direct service in 21 facilities, IHSC provides medical oversight for contracted health personnel to another 119 facilities. Under the IHSC’s governance, facilities are expected to provide uniform medical treatment to detainees, as delineated in ICE Performance-Based National Detention Standards (PBNDS). The mélange of governance arrangements comprising the medical service system within ICE detention facilities raises questions of medical care consistency. And as the political backdrop for ICE and immigrant rights has moved to the forefront of public debate, immigrant advocacy groups have published reports detailing substandard medical care in detention facilitates.

The purpose of this research is to explore the relationship between governance arrangements for ICE detainee health care – direct provision, contracts with states and local government health care providers, or contracts with private providers – and the subsequent health outcomes of detainees in these facilities. This study will utilize pooled panel data of more than 125 immigrant detention facilities between 2013 and 2015. A novel dataset is used combining publicly available data from the Department of Justice and ICE to examine the relationships described, as well as a series of control variables related to access and other elements of detention facility health programming. We will supplement that analysis with a qualitative component consisting of data from interviews with ICE and immigration advocacy groups to further explicate key findings.