This story was originally published by Popular Information, a substack publication to which you can subscribe here.
During the second Trump administration, the population of migrants held at US Immigration and Customs Enforcement facilities has exploded—from below 40,000 in January 2025 to over 73,000 today. Under the law, ICE is required to provide necessary medical care for this population.
While ICE employs some of its own medical staff, it often uses third-party providers. ICE’s Buffalo Federal Detention Facility, for example, houses over 500 detainees and has no doctor or dentist on staff.
ICE, however, has not paid any third-party providers for medical care for detainees since October 3, 2025. Last week, ICE posted a notice on an obscure government website announcing it will not begin processing such claims until at least April 30. Until then, medical providers are instructed “to hold all claims submissions.”
ICE’s failure to pay its bills for months has caused some medical providers to deny services to ICE detainees, an administration source who requested anonymity because they were not authorized to speak to the press told Popular Information. In other cases, detainees have allegedly been denied essential medical care by ICE.
ICE has not yet responded to a request for comment they received on Monday.
In lawsuits, numerous ICE detainees with severe illnesses allege that they cannot obtain treatment. For example, Viera Reyes, a detainee being held at ICE’s California City Detention Facility, has symptoms and test results that suggest he has prostate cancer.
But despite often being in excruciating pain, Reyes cannot obtain a biopsy. All of his requests to see a urologist have been ignored. Without a biopsy, Reyes has no formal diagnosis and cannot begin chemotherapy or take other steps to slow the cancer’s progression. Reyes was one of seven ICE detainees to sue over inhumane conditions at the California City facility.
How did this health crisis inside ICE detention facilities begin?
Beginning in 2002, the Department of Veterans Affairs played a small but critical role in providing essential medical care to ICE detainees. When a detainee needed medication or treatment that the ICE facility could not directly provide, the VA Financial Services Center processed reimbursement claims from pharmacies and third-party medical providers. ICE paid the VA for this service—no resources were diverted from veterans.
Beginning in 2023, however, the VA’s role in administering these claims from ICE was subject to criticism by Republican officials and right-wing media outlets. Senator Tommy Tuberville (R-Ala.), who introduced legislation to end the practice, falsely claimed Biden was “robbing veterans to pay off illegals.”
After Trump’s election, criticism of the VA’s role quieted down until, on September 30, 2025, the Center to Advance Security in America, a small right-wing nonprofit, filed a lawsuit. The CASA lawsuit sought to compel the Trump administration to respond to a public records request for documents regarding the VA’s role in administering medical claims from ICE.
According to government documents first reported by Popular Information, the VA “abruptly and instantly terminated” its agreement with ICE on October 3. That cancellation, according to the documents, left ICE with “no mechanism to provide prescribed medication” and unable to “pay for medically necessary off-site care.” Among the services ICE said it could not provide were “dialysis, prenatal care, oncology, [and] chemotherapy.” The documents were posted to SAM.gov on November 12 as part of ICE’s effort to hire a private contractor to process medical claims in place of the VA.
The situation was described by ICE as an “absolute emergency” that needed to be resolved “immediately” to “prevent any further medical complications or loss of life.”
More than three months later, the situation is not resolved, and it is expected to last until the end of April, if not longer. The process of replacing the VA, according to the administration source, has proven very complex. Acentra, one of the companies that won the ICE contract to replace the VA, says it will not be ready to process claims until at least April 30. Even if Acentra meets that target date, which is not a guarantee, claims filed on the first day may not be paid until May 30.
In the meantime, the situation with ICE detainees has grown so dire that the VA is now working to potentially bring its claims processing back online temporarily, the administration source said.
Internal administration data obtained by Popular Information reveals a massive gap in essential medical treatment for ICE detainees. The data shows that, in 2024, the VA processed $246.4 million in medical claims related to the treatment of ICE detainees by third parties. In 2025, despite an 83 percent increase in the daily detained population, the VA processed just $157.2 million in claims. (These figures include medical reimbursements from a much smaller number of detainees held by US Customs and Border Protection.)
Assuming the medical needs of a typical ICE detainee remain constant, the data suggests a nearly $300 million gap between needed care from third-party providers and what ICE paid. This gap is a combination of unpaid bills since October 3 and ICE detainees who are simply being denied necessary medical treatment.
An investigation by Sen. Jon Ossoff (D-Ga.) identified “85 credible reports of medical neglect, including cases that reportedly led to life-threatening injuries and complications,” among ICE detainees between January 20 and August 5, 2025. The incidents included “a heart attack after days of untreated chest pain, complications from untreated diabetes, and denial of necessary medications and associated complications.”
After October 3, medical care for ICE detainees almost certainly became much worse. And it is not likely to improve anytime soon.
