Proof of Citizenship at the Point of Care: Documentation Requests and Forgone Care Among California Immigrants,...

To estimate how often immigrant adults are asked for a Social Security number or proof of citizenship to obtain care or enroll in school, who is asked for these documents, and whether being asked relates to health care access.

Cross-sectional analysis of four pooled waves (2019-2022) of a population-based, multilingual survey of California adults. The exposure was the documentation request; outcomes were lacking a usual source of care and delaying or forgoing care.

California Health Interview Survey public-use files were used. The documentation item is asked only of foreign-born respondents, yielding 21,133 immigrant adults (15,313 naturalized, 5820 noncitizen). Survey-weighted logistic models with jackknife variance reported average marginal effects.

Overall, 15.7% (95% CI: 14.9-16.5) reported being asked. After adjustment, noncitizens were 5.3 percentage points more likely than naturalized citizens (3.5-7.1) and limited-English-proficient adults 5.8 points more likely (3.5-8.1) to be asked. Being asked was associated with delaying or forgoing care (6.1 points; 4.2-8.0) but not with lacking a usual source of care (0.2 points; -1.9 to 2.3).

Documentation requests were common, concentrated among noncitizen and limited-English-proficient immigrants, and associated with forgone care. The cross-sectional design cannot establish causation.