In Germany, health needs of citizens and ordinary residents are taken care of under the scope of statutory social and health insurance. The asylum-seeking population, however, receives healthcare through a parallel system, where decisions on provision of health services are not met at a central health governance level, but rather at federal state and sometimes at municipal level. The paper makes use of territorial administrative differences and randomization in redistribution of refugees across and within federal states in Germany to investigate the effect of bureaucratic restrictions in access to healthcare services for asylum seekers’ health and utilization of medical services.