Substance use problems affect millions of people in the United States, impacting individuals, their families, and communities. This problem affects people from all backgrounds, regardless of age, ethnicity, skin color, or immigration status. It impacts both citizens and non-citizens alike.
Although people who were not born in this country report lower rates of alcohol and substance use and are less likely to develop a substance use disorder or addiction , many still need help.[1]
Every person In the United States seeking medical attention has the right to it whether they are a citizen or non-citizen. That is the law.[2]In this article, we look at some important things to consider when getting substance use help for a loved one who is not a US citizen.
If your loved one has legal immigration status, they are in a better position to find help for substance use problems compared to other non-citizens. People with lawful immigration status include permanent residents (green card holders), asylum seekers, refugees, and all kinds of visa holders except tourist visas. They can access practically all the benefits citizens enjoy. This includes the ability to buy insurance through the Affordable Care Act (ACA).[3]
Also, people under parole programs (such as Cubans, Haitians, Nicaraguans, and Venezuelans), Temporary Protected Status (such as some people from El Salvador, Haiti, or Honduras) and DACA have legal status.
Despite having legal immigrant status as described above, a person with a substance use problem may face deportation if their substance use disorder has been diagnosed and is known by an immigration official. It may also stop non-citizens from getting permanent residency or prevent permanent residents from becoming US citizens.[4]
It’s also important to know that even though many states have decriminalized or legalized marijuana, the federal government still considers it an illegal drug. Using marijuana can lead to being denied an immigration benefit or even deportation.
The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that keeps patients’ health information private and sets standards for its use. It is designed to protect the health information of anyone who seeks medical attention, whether for a physical or a mental issue, such as a substance use disorder.
The personal health information of all patients—for citizens and non-citizens alike—is protected under federal law by the Health Insurance Portability and Accountability Act (HIPAA). Only a court can order a patient’s medical record, including any information about their immigration status, to be released. This can only happen in exceptional situations, and no federal agency alone—including Customs and Borders Enforcement (ICE)—can get someone’s medical records without a court order.[5]
People do not have to provide their immigration status to a medical provider.[6] Although immigration status is not personal health information, it may be protected under HIPAA if it is shared with other identifying information, such as the patient’s name or address. Any information that can identify someone—on its own or combined with other details–is protected by HIPAA.[7]
Although HIPAA laws are supposed to protect everyone’s medical information, there have been reports of people being arrested by immigration agents. The agents learned that they did not have legal immigration status, partly because of their medical records.[8]
In some cases, medical staff may illegally share a person’s medical records with immigration enforcement agents. While it doesn’t happen very often, it’s something to keep in mind if your loved one seeks help for a substance use problem.
Be mindful that ICE agents are allowed to be in the waiting area of a healthcare facility, where they can detain a non-citizen.[9]
If a HIPAA violation occurs, patients can file a legal complaint in most states. It may be helpful to ask about the privacy policies maintained by any provider your loved one is considering.
If you or your loved one live in states like Florida or Texas, be aware that the governors of these states require hospitals that receive government funding to ask patients about their immigration status. The stated reason is to calculate the cost of providing care to immigrants. According to these orders, the information is not supposed to be shared with immigration agencies.[10]
Hospitals that get Medicaid or Children’s Health Insurance Program (CHIP) funding must report immigration information to the state. However, they are also required to tell patients that their answers will not affect the care they receive, as protected by federal law.
In Florida, hospitals must tell patients their immigration status will not be reported to immigration authorities. In Texas, however, medical staff are not required to tell patients their information will not be shared.
Community health centers
Federally Qualified Health Centers (FQHCs) and Community Health Centers offer healthcare services on a sliding scale based on income. They provide care to everyone regardless of immigration status. Services often include behavioral health and substance use treatment.
Use this search tool to locate treatment facilities for mental and substance use disorders in the United States and its territories in a confidential and anonymous manner.
Nonprofit organizations
The nonprofit organization United We Dream created a directory of mental health providers who provide services at low or no cost.
Organizations like Harm Reduction Coalition or Latino-focused organizations such as La Clínica del Pueblo may have tailored programs.
Other organizations, such as the Salvation Army, also provide treatment and help for individuals with substance use problems, regardless of their immigration status.
Local and state-funded programs
Some cities have broader healthcare policies and offer state-funded programs that don’t require proof of citizenship or residency.
As of 2024, all adults in California eligible for Medi-Cal (Medicaid) based on income can enroll regardless of immigration status.
New York covers health services in the city’s hospitals and emergency care for other non-citizens in certain circumstances. Find locations here.
Low-cost private therapists
InclusiveTherapists.com is a therapist directory that can help you connect with therapists who share your cultural, racial, and ethnic backgrounds. They focus on helping vulnerable people and offer different payment options.
Open Path is a non-profit network of mental health professionals dedicated to providing in-office and online mental health care at reduced rates to clients in financial need. They are a welcoming network of professionals.
Confidential hotlines
SAMHSA’s National Helpline (1-800-662-HELP) is available 24/7 to provide free, confidential information on treatment options. Currently, they do not ask about immigration status and can direct individuals to local resources.
Faith-based organizations and cultural centers
Some churches, mosques, synagogues, and other religious or cultural organizations often provide confidential support, counseling, and substance use services in a confidential manner.
Emergency rooms and crisis centers
Emergency rooms are required by law (under the Emergency Medical Treatment and Labor Act) to treat anyone experiencing an emergency, regardless of immigration status. This can include detox services or referrals for substance use treatment.
Support groups
Groups like AA and NA are free and anonymous and don’t require legal status verification. These can be good options for ongoing peer support.
When seeking help, it’s a good idea to find organizations committed to providing care in a non-discriminatory, confidential manner.
For additional support, legal aid organizations like the National Immigrant Justice Center (NIJC) or Immigrant Legal Resource Center (ILRC) can provide information on rights and help reduce anxiety about seeking treatment.