If a person in immigration detention has a heart attack, the detention center calls an ambulance and a local hospital treats them. That is how it is supposed to work, and it is how it did work for about two decades.

On October 3, 2025, U.S. Immigration and Customs Enforcement abruptly stopped paying the third parties who provide that care. Eleven months later, many of them still have not been paid.

Who is holding the bag

UCHealth University of Colorado Hospital, in Aurora, has treated ICE detainees across roughly 150 hospital admissions, clinic appointments and emergency visits since last fall. It has not been paid for any of them, and is now carrying almost $4 million in unpaid bills.

Moshannon Valley EMS is a nonprofit ambulance service in Philipsburg, Pennsylvania. As of June, it had answered 43 calls to a local ICE detention center since October 2025. It has not been paid for any of that work either.

An ambulance company in rural Pennsylvania does not have a cushion for 43 unpaid runs. Neither of these organizations chose to take on ICE as a client. They answered calls.

How the system worked before, and why it stopped

Payment for detainee medical care used to be processed by the Department of Veterans Affairs, under an arrangement dating back to the George W. Bush administration. It was a paperwork pipeline: the VA already ran a large medical claims operation, so ICE used it.

That was not small. In 2024 the VA processed more than $246 million in medical claims for people detained by ICE and, in much smaller numbers, by Customs and Border Protection. Records obtained by American Oversight show it processed $96 million in 2025 before the relationship ended.

The VA terminated it after right-wing activists attacked the arrangement, claiming immigrants were draining resources from veterans. What the VA was actually doing was processing paperwork ICE paid for.

The replacement has not processed the claims

Three weeks after the shutoff, ICE signed an emergency contract with a company called Acentra Health to take over claims processing. The federal contract record, dated October 25, 2025, shows ICE has committed $53 million to it and paid out more than $40 million.

ICE originally said claims processing would begin on April 30, 2026. That date has been pushed back repeatedly, with no current estimate.

So the government has paid a contractor more than $40 million to build a system that has not yet paid a hospital.

People are dying in this system

The unpaid bills are the accounting problem. There is a human one underneath.

In the 500 days between the inauguration on January 20, 2025 and June 4, 2026, 52 people died in ICE custody in the United States, according to a June 2026 report by Human Rights Watch and Physicians for Human Rights. That mortality rate, the report says, "is nearly four times that of the Biden administration, and more than two and a half times as high as that of the first Trump administration."

Those two facts belong in the same paragraph. The agency in whose custody people are dying at nearly four times the previous rate stopped paying the outside doctors and ambulance crews who treat them — and has not fixed it in eleven months.

A hospital cannot legally turn away an emergency patient. But an ambulance service that goes broke stops existing, and a hospital that eats $4 million makes it up somewhere. In Aurora, that somewhere is other patients.

What the record shows

ICE stopped paying hospitals, clinics and ambulance services for detainee medical care on October 3, 2025, after the Department of Veterans Affairs ended a claims-processing arrangement that had run since the Bush administration and handled more than $246 million in 2024 alone. Eleven months on, a single Colorado hospital is owed almost $4 million across roughly 150 visits, and a nonprofit Pennsylvania ambulance service has gone unpaid for 43 calls. ICE has paid a replacement contractor more than $40 million and has still not begun processing the claims. In the same period, 52 people died in its custody.

Sources

UPDATE: ICE is leaving hospitals with millions in unpaid bills — Popular Information, September 1, 2026. Photo: Alex Wong / Getty Images.

ICE hasn't paid UCHealth hospital since last year for immigrant health care — CPR News, August 18, 2026.

Dying in Detention: Rising Deaths in an Expanding US Immigration Detention System — Human Rights Watch and Physicians for Human Rights, June 25, 2026.