An estimated 6,500 undocumented immigrants with end-stage renal disease (ESRD) reside in the United States.1 The availability of standard outpatient (thrice-weekly) hemodialysis for undocumented immigrants with ESRD varies throughout the country. Although many states offer emergency-only hemodialysis (dialysis only after an emergency department evaluation), others offer standard hemodialysis.2 This considerable variation by state is due to the lack of a national policy. Undocumented immigrants with ESRD are eligible for neither the 1972 Medicare ESRD entitlement program nor full-scope Medicaid coverage.