Changes to Data Sharing Policies Impacting Care Delivery 

July 29, 2025

Background

Recent reports indicate that U.S. Immigration and Customs Enforcement (ICE) has been accessing personal health care data from individuals enrolled in the Medicaid program through a reported Memorandum of Understanding Between HHS/CMS and ICE. The use of personal health information (“PHI”) for immigration enforcement purposes could deter legal immigrant families and their communities from seeking necessary medical and mental health services. This could lead to a number of negative consequences, including a decline in overall health for American citizens and non-citizens alike and an increase in health disparities. 


Medicaid is a federal and state program that provides health care to millions of low-income Americans, a group that includes "citizens and qualifying non-citizens." Federal law restricts eligibility based on immigration status, meaning that many non-citizens, including those with undocumented status, are not eligible for comprehensive coverage. This creates complex situations, particularly for families with mixed immigration status, and across states that have different reporting requirements. For example, U.S.-born children may be eligible for Medicaid and in need of care, while their parents are ineligible. In these circumstances, the process of enrolling a child can create immense fear for a family, as they worry that the medical data provided for their child's health care could be used to identify and target ineligible family members for immigration enforcement. 


The American Psychological Association's Ethical Principles of Psychologists and Code of Conduct emphasizes the importance of protecting confidential information and respecting the rights and dignity of all individuals. 


Psychologists have a critical role to play in advocating for policies that protect vulnerable populations and ensure that all individuals have access to the care they need without fear of reprisal. This new federal government policy underscores the urgency of these efforts and highlights the need for continued vigilance in safeguarding patient privacy.

APA/APASI Assessment

The practice of using protected health information (“PHI”) from Medicaid for immigration enforcement is a privacy breach and creates the potential for psychological harm to vulnerable communities and undermines public health. This policy is profoundly damaging, creating a climate of fear that will deter noncitizen individuals and families—including those with mixed immigration statuses—from seeking essential health and mental health care. This policy change may also influence citizens’ decisions to seek physical and mental health care, as fear of having their private information used for non-health related purposes may drive them to avoid care altogether. Making such drastic changes to the health care system in this way may transform health care environments into sources of harm, a reality that directly contradicts the core principles of beneficence and nonmaleficence in the APA’s Ethical Principles of Psychologists and Code of Conduct.

APA’s Position

APA opposes the use of an individual's PHI for the purposes of immigration enforcement. 


Our position is grounded in our Ethical Principles of Psychologists and Code of Conduct, which mandates that psychologists protect confidential information and safeguard the welfare and rights of their patients. Specifically, APA maintains that: 

 

  1. Confidentiality is sacrosanct: The privacy of health information is a cornerstone of the therapeutic relationship, fostering trust that is essential for seeking care. 
  2. Health care must be a safe zone: Health care settings must remain trusted spaces for all people, regardless of immigration status. Allowing immigration enforcement to access health records is a breach to personal and confidential information while eroding patient safety.
  3. Policies must promote health equity and fairness: This practice discriminatory, disproportionately harms immigrant communities, creating systemic barriers for care and exacerbating already present health disparities that are antithetical to the goal of fairness and well-being for all. 


APA Services, Inc. (APASI), calls on the Department of Health and Human Services and the Department of Homeland Security to create robust firewalls to ensure PHI is used solely for its intended purpose. 

What APA is Doing

In response, APASI is taking immediate action. We are:


  • Engaging directly with the Department of Health and Human Services (HHS) and the Department of Homeland Security (DHS) to express our concerns that such data-sharing between the two agencies is unjust and may involve patients' confidential PHI, including mental health records, potentially deterring individuals from seeking needed mental health services. 
  • Collaborating with our coalition partners in the health care, public health, immigrant, and civil rights sectors to present a unified front against this policy. 
  • Actively educating members of Congress on the severe psychological and public health consequences of allowing such a policy and advocating for legislative solutions to reinforce privacy protections for sensitive health information. 
  • Providing guidance to psychologists to help them navigate the ethical dilemmas this policy creates and empowering their own advocacy for patients. 


APA and APASI are committed to health care remains a safe and confidential space. We will continue to advocate for a reversal of this harmful policy and to uphold the privacy protections safeguarding patient health information and the values of our profession.