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Over the past several decades, citizenship status has become more important in immigrant lives and communities in the United States. Undocumented adults who arrived as children, the 1.5 generation, comprise a growing percentage of the immigrant population. Although they are similar to children of immigrants born in the United States (the second generation) they face a variety of barriers to integration due to their lack of legal status. Based on over five years of ethnographic fieldwork with mainly 1.5 and second generation Mexican-American men during a period of major healthcare reform, this paper addresses how citizenship status and embeddedness within multi-status communities impacts immigrant experiences in the health-care domain. In particular, I argue that the Affordable Care Act (ACA) has contributed to an institutionalization of the status differences and a further differentiation in the social integration of these groups of children of immigrants. The novel methodological approach and the data which emerges through fieldwork reveals important insights into the process whereby healthcare reforms have consequences for immigrant communities which I show through highlighting the status-signaling event that is generated through various forms of direct and indirect interaction with the ACA. The implications of this extend beyond healthcare, and I discuss its impact on issues including ethnic identity and psychological well-being. This paper makes contributions to both our understanding of intergroup dynamics in immigrant integration and the health implications of immigration policies more generally.