Immigration and Customs Enforcement has not paid outside medical providers for detainee care for nearly a year, according to an investigative report, and advocates believe the move is intentional neglect.
The Department of Veterans Affairs abruptly ended a longstanding arrangement to process ICE's medical claims Oct. 3, 2025, the San Francisco Chronicle found, and the lapse, coinciding with record detention numbers and a $104 billion ICE budget, has left hospitals and ambulance services owed millions and contributed to delayed or canceled care for detainees with serious conditions.
The VA severed the agreement after pressure from Republicans who argued it diverted resources from veterans, despite VA officials noting ICE reimbursed the department for the work.
ICE has since called the resulting gap an "absolute emergency" and hired a new vendor, Acentra Health, under a $67.5 million contract to rebuild its claims system — but as of August, the system still wasn't operating.
An internal ICE directive obtained by the Chronicle instructed staff to limit offsite care to emergencies and directed detention centers to transport detainees to hospitals themselves, anticipating ambulance companies might refuse uncompensated calls.
Reporters identified at least eight detainees whose care was delayed or denied in ways independent physicians said endangered their health, including a Los Angeles man with recurring throat cancer who waited months for an oncology referral, and an asylum seeker whose seizures went unmanaged after medication lapses tied to his brain tumor.
Advocacy groups have taken to calling the situation a "death policy," and Adina Applebaum of the Amica Center for Immigrant Rights told the Chronicle the lack of care reflects "a deliberate policy choice, not an accident."
A Department of Homeland Security spokesperson disputed that characterization, saying detainees retain access to on-site care, emergency treatment and offsite specialty referrals, and that scheduling delays are common and outside the agency's control.
The payment breakdown has also led some facilities to bill detainees directly for care, despite ICE detention standards requiring free medical treatment.
The Chronicle documented cases including a $634 blood test charge and a $17,210 hospital bill for emergency gallbladder surgery performed on a detainee handcuffed to his bed.
Legal experts, including UC Berkeley law dean Erwin Chemerinsky, said federal law requires the government to cover medical costs for people in its custody, calling the billing practice unconstitutional.
Two House Democrats, Reps. Delia Ramirez (D-IL) and Mark Takano (D-CA), have asked Homeland Security to investigate the lapse, citing what they described as a rise in detainee deaths and health complications.
A former ICE official said oversight of improper billing has weakened since staff cuts to the agency's civil rights office, calling the failures a "systemwide problem."