​Summary: In the last thirty years, major shifts in immigrant policy at national and state levels have heightened boundaries among citizens, permanent residents, and those with other statuses. While there is mounting evidence that citizenship influences immigrant health care inequities, there has been less focus on how policies that reinforce citizenship stratification may shape the extent of these inequities. Authors examine the extent to which the relationship between citizenship and health care inequities is moderated by state-level criminalization policies.

Taking a comparative approach, authors assess how distinct criminalization policy contexts across U.S. states are associated with inequitable access to care by citizenship status. Utilizing a data set with state-level measures of criminalization policy and individual-level measures of having a usual source of care from the pooled 2014–2015 National Health Interview Survey data, authors use mixed-effects logistic regression models to assess the extent to which inequities in health care access between noncitizens and U.S. born citizens vary depending on states' criminalization policies.

Findings: Each additional criminalization policy was associated with a lower odds that noncitizens in the state had a usual source of care, compared to U.S.-born citizens.

Criminalization policies shape the construction of citizenship stratification across geography, such as exacerbating inequities in health care access by citizenship.