Unauthorized Immigrants’ Access to COVID-19 Vaccines

Unauthorized Immigrants’ Access to COVID-19 Vaccines

INSIGHTi

Unauthorized Immigrants’ Access to
COVID-19 Vaccines
February 25, 2021
COVID-19 vaccines have been widely viewed as a means of reducing the spread of COVID-19 and
facilitating a return to work and school. In general, for COVID-19 vaccines to effectively reduce disease
transmission, a large percentage of the population must be vaccinated. This includes anyone who resides
in the United States regardless of their authorization to do so. This Insight covers the distribution of
COVID-19 vaccine to unauthorized immigrants (sometimes referred to as undocumented) in the United
States—a population that may face barriers to vaccine access.
The Unauthorized Immigrant Population
Of the 44.8 million foreign-born individuals residing in the United States in 2018, about one-quarter (10.5
million) were estimated to be unauthorized immigrants. While unauthorized immigrants are excluded
from many types of federal benefits, 8 U.S.C. 1611(b)(1)(C) makes an explicit exception “for
immunizations with respect to immunizable diseases.”
Vaccine Funding and Costs
Nearly half (45%) of the nonelderly (i.e., under the age of 65) unauthorized population in the United
States did not have health insurance in 2017. Lack of insurance generally may be a barrier to accessing
health services. However, COVID-19 vaccines are being provided for free because the vaccine was
acquired by the federal government through federal purchasing. Providers are not permitted to charge for
the vaccine itself and thus may not deny the vaccine based on inability to pay. They may charge an
individual’s public or private insurance plan for administration, storage, and other costs. For those
without coverage, they may charge the Uninsured Fund for these ancillary costs. (They are prohibited
from charging an individual out-of-pocket for any costs.) The Frequently Asked Questions about the
Uninsured Fund states that providers are not required to confirm immigration status prior to submitting a
claim. In addition, some states have extended coverage for vaccines to otherwise eligible unauthorized
immigrants under emergency Medicaid, or through a temporary Medicaid disaster relief state plan
amendment in the case of the Commonwealth of the Northern Mariana Islands.
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Prioritization
The Advisory Committee on Immunization Practices (ACIP) has made recommendations for how initial
vaccine supply should be prioritized, adopted as Centers for Disease Control and Prevention (CDC)
recommendations. States/localities are setting priority groups for their programs and have made their own
determinations balancing considerations such as risk of infection, equity, and speed of the vaccination
program. The federal government has stated that unauthorized immigrants should have access to the
vaccine. Portions of the unauthorized immigrant population are likely to be included in groups that are
receiving early priority based on their age, having certain underlying medical conditions, or based on
being an essential worker. An estimated 5.5 million unauthorized immigrants are employed in “essential
critical infrastructure” categories during the COVID-19 response, as defined by the Department of
Homeland Security (DHS). Notably, some of these individuals may have employment authorization (e.g.,
certain Temporary Protected Status or Deferred Action for Childhood Arrivals recipients).
Vaccine Barriers
Though the federal government has made vaccines free of charge and stated that unauthorized immigrants
should have access to vaccines, several barriers may still affect unauthorized immigrants’ decisions to
seek vaccination.
Immigration Enforcement Fears
The unauthorized immigrant population may be hesitant to receive the vaccine because of fears about
immigration enforcement, such as being arrested at the vaccination sites. However, Immigration and
Customs Enforcement (ICE) has a long-standing policy of not taking enforcement actions (e.g., arrests,
interviews, and searches) at certain “sensitive locations,” which include medical treatment and health care
facilities. Further, the Biden Administration affirmed that vaccination sites are included within the scope
of sensitive locations. As such, immigration enforcement should not occur at vaccine sites “except in the
most extraordinary of circumstances.”
In addition, immigration enforcement fears are prevalent among the unauthorized population because
vaccine providers often require individuals to register and some may require government issued
identification, which unauthorized immigrants may not have or may be fearful to present. Further, some
personally identifiable information is being collected (e.g., name, ID) to track vaccine recipients and
monitor coverage across the population. Some individuals fear these data will be shared with ICE.
However, according to the CDC, vaccine data may not be used “for any civil or criminal prosecution or
enforcement, including, but not limited to, immigration enforcement.”
The Chilling Effect of the Public Charge
Under the DHS public charge rule, noncitizens can be denied admission or adjustment to lawful
permanent resident status based on past or potential future use of public benefits (for more information,
see CRS In Focus IF11467, Immigration: Public Charge). This appears to have had a chilling effect on
immigrants’ use of public benefits, including health care services. Observers are concerned that fear and
misinformation surrounding the public charge rule could deter unauthorized immigrants from seeking the
COVID-19 vaccine. U.S. Citizenship and Immigration Services announced that it will not consider any
“testing, treatment, nor preventative care (including vaccines)” for COVID-19 as part of the public charge
inadmissibility determination.

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Sociodemographic Factors
Unauthorized immigrants may face other barriers to getting the vaccine because of their socioeconomic
status, where they reside, or limited English proficiency. The Consolidated Appropriations Act, 2021 (P.L.
116-260), included funds for the CDC to target “high-risk and underserved populations, including racial
and ethnic minority populations and rural communities” as part of its vaccination efforts. Such efforts
may also include immigrant communities because they may be high risk or lack access to care. In
addition, vaccine information is being made available in a number of languages to facilitate access.
Issues for Congress
The federal government, among others, is undertaking efforts to lessen the barriers unauthorized
immigrants may face when seeking a vaccine. Congress may consider bills that aim to reduce these
barriers and to monitor whether efforts are sufficient. Vaccines are being distributed at the state and local
levels, so oversight could examine differences by jurisdiction in uptake and data collected that may
provide information on vaccine coverage by subgroups. As mentioned, the Uninsured Fund is being used
to pay for vaccine administration costs for the uninsured. The amount allocated for uninsured vaccines
has not been specified, and more than two-thirds of the amounts appropriated to the Provider Relief Fund
have been allocated. As such, fund availability may be another issue for Congress to monitor.

Author Information

Elayne J. Heisler
Abigail F. Kolker
Specialist in Health Services
Analyst in Immigration Policy

Disclaimer
This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan shared staff
to congressional committees and Members of Congress. It operates solely at the behest of and under the direction of
Congress. Information in a CRS Report should not be relied upon for purposes other than public understanding of
information that has been provided by CRS to Members of Congress in connection with CRS’s institutional role.
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