Mass. attorney general offers broad guidance to health care providers on responding to ICE requests

Ethan Marks, deputy division chief of the Health Care Division at the Massachusetts Attorney General’s Office, told the Permanent Commission on the Status of Persons with Disabilities’ workforce support subcommittee that the office issued health care guidance at the end of January to help providers and patients respond to U.S. Immigration and Customs Enforcement (ICE) requests.

"This is a guidance that includes information for both health care providers and patients," Marks said, to explain what the document covers and where to find contact information for civil rights complaints.

The guidance, Marks said, was written because providers are concerned about how to respond if ICE conducts enforcement activities at health care facilities or requests information about patients — and because some individuals may be deferring needed care out of fear. It addresses what a provider should do if ICE asks for information about a patient, what level of access ICE officials may have at health care facilities, how facilities can prepare for potential enforcement activity and what types of documents an ICE official may present.

"Providers have also been concerned that individuals may be deferring necessary health care out of fear," Marks said, describing part of the reasoning behind the memo.

Marks told the subcommittee the guidance is intended to be broad: "I think for the purpose of the guidance we put out, I think we aim for it to be very broad," and that staff are available to answer questions about how the guidance applies to particular factual scenarios, such as group homes or program sites licensed by the Department of Developmental Services or Department of Mental Health.

Commissioners and subcommittee members sought practical clarifications. One member asked whether residential programs and DDS‑ or DMH‑licensed group homes should be treated the same as other health care facilities; Marks said the guidance was drafted to cover the landscape of health care facilities but that there may be nuances and the AG’s civil rights division can provide more tailored advice.

The guidance also addresses access to care, Marks said, including whether receiving government‑subsidized care or applying for MassHealth affects immigration status and which programs are available regardless of immigration or citizenship status. Marks said the AG’s Office will continue to monitor federal executive orders, rulemaking and legislation and will update the guidance if appropriate.

Committee members urged broad dissemination of the guidance. A commissioner asked whether the Attorney General’s Office had reached out to the Massachusetts Hospital Association; Marks said the office has tried to distribute the guidance widely and would check whether it had contacted that association.

Subcommittee members also recommended sharing the materials with academic institutions that train health care workers, student clinicians and other frontline trainees. Marks said the office would check internally and, if possible, share a list of stakeholders with the commission.

On the question of whether ICE activity at health care facilities has been seen recently, Marks said he was not aware of "any sort of significant activity" at health care facilities but acknowledged there is fear and that the office has heard reports and rumors.

The subcommittee agreed to circulate the guidance to partner agencies and contacts and to follow up on dissemination contacts the Attorney General’s Office can provide. The AG’s guidance includes a civil rights division phone number and a health care division contact for reporting incidents or asking for clarification.