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Welcoming Care for Migrant Communities

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This activity is available for 0.25 CME/CE credit(s).

Released: October 29, 2026

Expiration: October 28, 2027

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Invisible barriers, such as concerns about immigration enforcement, can affect entire families, including US-born children. Concerns for one’s immediate safety can feel more pressing than addressing healthcare needs and may prevent patients from receiving essential care. So, what can healthcare professionals and health systems do?

Kathleen Raquel Page
Kathleen Raquel Page, MD
Migrant Communities

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Some time ago, our local health department asked me to see a woman from Central America who had been diagnosed with syphilis during pregnancy. As a native Spanish speaker, I reached out to her and arranged a same-day appointment at our free sexual health clinic. She told me she was on her way but never arrived. When I called her again, she explained that she had reached the clinic but decided to leave after seeing a security guard because she had no “papers.”

To most of us, a security guard at the desk feels safe and routine, but to her it felt risky. She was taking a leap of faith entering an unfamiliar clinic on the recommendation of an unfamiliar physician and, at the door, the fear of deportation outweighed the perceived benefit of treating a condition that was causing her no symptoms. 

This experience shows how barriers that are invisible to healthcare professionals can prevent patients from receiving essential care. Concerns about immigration enforcement can affect entire families of migrant individuals, including their US-born children.

So, what can healthcare professionals and health systems do?

Create welcoming spaces. Provide clear, multilingual information about services, costs, identification requirements, confidentiality, and the role of security. Train reception and security staff alongside clinical teams on interpretation services, patient protections, and protocols for the presence of law enforcement in clinical spaces. Every person on the care team plays a role in making our clinics welcoming to immigrant patients. 

  • Protect privacy. Avoid unnecessary questions about immigration status or recording that information in the medical record. Explain confidentiality protections and their limits in plain language. Clearly designate private clinical areas and establish an institutional protocol for responding to immigration agents or requests for information, with prompt access to legal counsel.
  • Offer flexible pathways into care. Telemedicine, pharmacy delivery, flexible scheduling, transportation assistance, and services offered through trusted community partners can help patients remain engaged. Community health workers or patient navigators, if available, can be instrumental in building trust and helping patients navigate the system.
  • Follow up after missed appointments. Reach out to patients who miss appointments to explore obstacles to care and concerns about safety. Ask how patients prefer to be contacted and whether messages can be left. Offer alternatives to in-person visits, if appropriate, and clarify misunderstandings without dismissing underlying concerns.
  • Plan for continuity of care. Help patients keep an updated medication list and copies of essential records. Offer patient portal enrollment and assistance. For people with HIV, discuss how to minimize the risk of treatment interruption in case of relocation, detention, or other disruptions. Before or after a move, help arrange for medication access, provide an HIV treatment summary, and connect to an HIV clinic at their destination whenever possible. Identify a trusted contact who could help pick up medications if care is disrupted. Confirm whether they know the patient’s HIV status and document what information may be shared. Offer know-your-rights resources and information about qualified legal assistance.
  • Create room to discuss concerns without demanding disclosure. Immigration-related stress may present as anxiety, depression, sleep problems, or changes in physical health. Start with open-ended questions: “How are you doing?” or “How have your stress levels been?” Pause and listen. Patients should not have to disclose immigration status to receive compassionate care.

Looking back, I thought I had done my duty in making care available to this patient, even speaking with her in her native language to put her at ease. However, I never anticipated what unseen barriers might keep her away. For the woman who turned back after reaching the clinic door, access meant more than an available appointment. It meant feeling safe enough to walk inside. [Coder link to Text module 2 when available: Overcoming Barriers to HIV Care for Foreign-Born People Living With HIV in the United States]

Your Thoughts:
What would you do next to try and re-engage this patient in care? Leave a comment to join the discussion!

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