Providers report fewer visits, more telehealth use and growing legal demand as immigrant families avoid clinics, courts and police.
Casa Marianella, seen here in 2019, provides shelter and supportive services to refugees, political asylum seekers and immigrants. Paloma Ramos said the line to access Casa Marianella’s benefits clinic had historically snaked past its entrance from open to close.
Since the increase in immigration enforcement across the U.S. and in Texas, that line has dwindled in size, with sometimes only “one or two people” coming in a day, she said. “It’s the fear,” said Ramos, a benefits coordinator at Casa Marianella, which provides shelter and supportive services to refugees, political asylum seekers and immigrants. She said the shift began “at the start of 2025.”Advocates and providers say fears of officers showing up at clinics and courtrooms have permeated the immigrant community, leading some immigrants to miss out on essential services.Paloma Ramos, a benefits coordinator at Casa Marianella’s benefits clinic, works at her computer on Feb. 27. She said that since the increase in immigration enforcement across the U.S. and in Texas, the clinic has seen a decline in clients. If it’s “just a simple cold, they just find home remedies — traditional remedies,” Ramos said. “It’s a difficult situation.” Casa Marianella’s benefits clinic supports clients in accessing services such as medical, dental and mental health care. Benefits coordinators like Ramos frequently help clients enroll in the, one of 1,400 health centers nationally serving those who are uninsured or underinsured, operates clinics across Travis County serving MAP patients. The network provides service regardless of a patient’s ability to pay and does not track immigration status, said Tara Trower, deputy CEO and chief strategy officer. “When I talk to our providers, they say that some of their patients say they’re afraid and they’re limiting their visits,” Trower said. “We still see demand. Folks are still coming in,” she said. “There is some fluctuation on days if, for example, ICE or law enforcement is parked nearby one of our clinics, but folks are still coming in.” The health system has expanded its telehealth capabilities in recent years, though not specifically in response to concerns about federal agents targeting clinics. Trower said the option has helped patients facing transportation barriers as well as those who are worried about ICE. While ICE has not yet targeted CommUnityCare facilities, Trower said the possibility “is always a thought. Watching the headlines, it would be silly for us not to be aware.”the Austin Police Department contacted ICE when responding to a domestic disturbance in Southwest Austin. Honduran-born Karen Gutiérrez Castellanos and her 5-year-old daughter were both arrested and later deported. The incident prompted public outrage and triggered the police department’s review of its general orders concerning officers’ responses to federal administrative warrants. Beyond this, Pierre Berastain, CEO of, worries it will have a chilling effect on women reporting domestic violence. The SAFE Alliance serves survivors of abuse, domestic violence and sexual assault.The Violence Against Women Act “That made it easier and incentivized survivors to come forward and report those crimes,” Berastain said. “Unfortunately, when fear of enforcement escalates, it doesn’t just affect the immigration outcomes. It undermines survivor safety.”Berastain said, if anything, more people have turned to The SAFE Alliance since federal operations intensified. “We have seen an increase of people reaching out to SAFE … in terms of not trusting calling 911,” he said. And it’s not just “immigrants calling us. I’m talking about people at large saying, ‘We don’t trust the system.’”“There was an increase in requests for services, but also an increase in requests for just accurate information, people not knowing what to do, not knowing what their rights are, what they needed to do to protect themselves and their families,” said Edna Yang, co-executive director of American Gateways.“The spike is not just undocumented immigrants, but also people who have status, lawful status, who are unsure if that lawful status protects them anymore because of some of the rhetoric that’s out there,” Yang said. Permanent residents are canceling travel plans, some immigrants are hesitating to apply for citizenship and others are missing court hearings, Yang said. “The constant in the communities that we serve is fear. It’s fear of the chaos and the unknown.” “It’s just confusion overall, because there have been so many changes,” she said. “It’s really hard to keep track. I will say, as an immigration practitioner, it’s hard to keep track.”
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