When considering health care and immigration, its important to identify the different family forms and immigration status of each family and indeed each individual within the family. Immigrant families may consist of all legal immigrants, a combination of legal and undocumented immigrants, legal immigrant citizens and legal immigrant non citizens, foreign born children adopted by US citizens, and families in which the children were born in the US (and therefore full citizens and not immigrants at all) but the parents are either legal or undocumented immigrants as well as refugee families. The reason it is important to identify these family forms is that immigration status has a huge impact on an families ability and willingness to access health care. As little as 50% of immigrant children have health insurance (including medicaid) compared to only 15% of non-immigrant children, coverage is even lower for adult immigrants. One of the reasons that so few immigrants have access to health insurance is that in 1996 legislation called Personal Responsibility and Opportunity to Work Act which stops government assistance for legal immigrants for the first five years in this country. Undocumented immigrants generally have no health care. When an individual has no insurance they are less likely to seek preventative treatment such as well child visits, prenatal care and treatment for chronic conditions and more likely to use the emergency room as their primary form of health care. Many immigrant families are reluctant to seek health care even if they are here legally and have insurance because they have a close family who is in the country (and maybe living in the same home) as an undocumented immigrant and they fear triggering an investigation which could result in that loved one being deported. Other barriers to quality health care include lack of familiarity with accessing US health care, limited understanding and communication skills in English and limited financial means to pay co-pays etc. Immigrants are at increased risk for many health conditions not found in the general US population including preventable diseases that most US born children are inoculated against, such as Hepatitis B and chickenpox. As well, there may be health problems that boarders of the US as are undiagnosed, including tuberculosis, parasites, HIV, AIDS, diabetes, and Hypertension, to name a few. Limited money may lead to poor quality or insufficient food, anxiety and depression. Children in particular (who have no control over where they live) are at risk for mental health problems due to the trauma of a move and because of stresses that may have occurred in their country of origin to precipitate to move. Health care should be available to all individuals residing in the US because infectious diseases can be spread to anyone regardless of their immigration status. In other words, whole communities can be at risk when individuals are not receiving proper health care. Additionally when persons use the emergency room as their primary means of health care costs of care go up for insured individuals i order to compensate for the inability of some to pay their hospital bills for conditions that could have been prevented with care such as prenatal doctors visits. In the city of Hartford there are some services available to all individuals, with or without health insurance that do not actively seek to exclude undocumented aliens. Those include Burgdorf medical clinic which works on a sliding scale so that individuals can access affordable care. Their services include preventative and acute care for children, adults and pregnant woman. They have walk in appointments and HIV clinic hours and provide screening for a wide range of diseases. The Malta House of Caring is a mobile clinic that moves around to different areas in Hartford and provides non-emergency care for free. They treat basic ailments and administer medication and make referrals to other care providers in the Hartford area for conditions they are not equipped to treat.