Trump’s HHS Orders State Medicaid Programs To Help Find Undocumented Immigrants
The Trump administration has ordered states to investigate some Medicaid enrollees to determine whether they are ineligible because of their immigration status, with five states reporting they have collectively received more than 170,000 names — an “unprecedented” move by the federal government that ensnares the state-federal health program in the president’s immigration crackdown.
Advocates say the push saddles states with duplicate verification checks and could lead to people losing coverage simply for missing paperwork deadlines. But Centers for Medicare & Medicaid Services Administrator Mehmet Oz said in an article on Social Platform
Overall Medicaid spending exceeded $900 billion in fiscal year 2024.
It’s not clear from Oz’s statement or the accompanying video over what time period the spending occurred, and CMS spokespeople did not immediately respond to questions, either for an earlier version of this article or after Oz’s statement was released.
Only U.S. citizens and certain legally present immigrants are eligible for Medicaid, which covers low-income and disabled people, as well as the closely related Children’s Health Insurance Program. People without legal status are not eligible for federally funded health coverage, including Medicaid, Medicare, and plans through the Affordable Care Act marketplaces.
At least one state said it disagreed with Oz’s comments.
“Our payments for coverage for undocumented people are consistent with state and federal law,” said Marc Williams, a spokesman for the Colorado Department of Health Care Policy and Financing, which administers the state’s Medicaid program. “The $1.5 million figure cited today by federal leaders is based on an incorrect preliminary finding and has been refuted and supported by our department’s experts.”
He added: “It is disappointing that the administration is announcing this number as final when it is clearly overestimated and the conversations are really at the education and discussion phase. »
In August, CMS began sending states the names of Medicaid enrollees the agency suspected were ineligible, requiring state Medicaid agencies to verify their immigration status.
KFF Health News contacted Medicaid agencies in 10 states in October. Five of them provided the approximate number of names they had received from the Trump administration, and expect more to come: Colorado received about 45,000 names, Ohio 61,000, Pennsylvania 34,000, Texas 28,000 and Utah 8,000. More than 70 million people are enrolled in Medicaid.
Most of these states declined to comment further. Medicaid agencies in California, Florida, Georgia, New York and South Carolina declined to say or did not respond how many names they had been ordered to review.
Oz said in his Article
“We notified the states and many started paying the money back,” he said. “But what if we never asked?”
Washington, D.C. Medicaid Director Melisa Byrd said CMS identified administrative expenses for the district program that covers people regardless of immigration status that should not have been billed to the federal government and that her agency has already addressed some of those areas. “We run a large, very complex program and when errors or mistakes occur, we correct them,” she said.
The program plans to return $654,014 to CMS by mid-November.
All five states, plus Washington, D.C., are led by Democrats, and President Donald Trump did not win any of them in the 2024 election.
In recent days, Assistant Secretary of Health and Human Services Jim O’Neill began posting photos on X of people he considers convicted felons living in the United States without authorization and receiving Medicaid benefits.
O’Neill could not be reached for comment.
“We’re very concerned because this seems, frankly, to be a waste of state resources and to advance the administration’s anti-immigration agenda,” said Ben D’Avanzo, senior health advocacy strategist at the National Immigration Law Center, an advocacy group. “This duplicates what states are already doing,” he said.
As part of the administration’s crackdown on people residing in the United States without authorization, President Donald Trump in February ordered federal agencies to take steps to ensure they do not obtain benefits in violation of federal law.
In June, advisers to Health and Human Services Secretary Robert F. Kennedy Jr. ordered CMS to share information about Medicaid enrollees with the Department of Homeland Security, leading to a lawsuit by some states alarmed that the administration would use the information for its eviction campaign against unauthorized residents.
In August, a federal judge ordered HHS to stop sharing this information with immigration authorities.
State Medicaid agencies use databases maintained by the Social Security Administration and the Department of Homeland Security to check enrollees’ immigration status.
If states must ask individuals to double-check their citizenship or immigration status, it could lead to some disappearing unnecessarily — for example, if they don’t see a letter requesting documents or don’t meet a deadline to respond.
“I’m not sure the evidence suggests that this additional verification is really necessary,” said Marian Jarlenski, a health policy professor at the University of Pittsburgh School of Public Health.
Oz made it clear that the Trump administration disagreed.
“Whether deliberate or not, the states’ conduct highlights a terrifying reality: American taxpayers footed the bill for Medicaid coverage for illegal immigrants, despite the insistence of many Democrats and the media,” Oz said in his X post.
In an August press release, CMS said it would ask states to verify the eligibility of enrollees whose immigration status could not be confirmed through federal databases. “We expect states to take rapid action and will monitor progress on a monthly basis,” the agency said.
Leonardo Cuello, a research professor at Georgetown University’s Center for Children and Families, called the CMS order “unprecedented” in the 60-year history of the Medicaid program.
He said the federal government may not be able to verify the immigration status of some people because names are misspelled or outdated, such as when a beneficiary is identified by their maiden name instead of their married name. The names may also include people helped by Emergency Medicaid, a program that covers the cost of emergency hospital services, including labor and delivery, for people regardless of their immigration status.
“CMS is conducting unnecessary reviews of the immigration status of people whose hospital bills were paid by Emergency Medicaid,” Cuello said.
Oz noted in his article that federal law “allows states to use Medicaid dollars for emergency treatment, regardless of patients’ citizenship or immigration status,” and that states can “legally create Medicaid programs for illegal immigrants using their own tax dollars, provided that no federal tax dollars are used.”
The states Oz mentions all operate their own such programs.
The audit checks create an additional burden for state Medicaid agencies that are already busy preparing to implement the tax and policy law Trump signed in July. The measure, which Republicans call the One Big Beautiful Bill Act, makes numerous changes to Medicaid, including adding a work requirement in most states starting in 2027. The law also requires most states to check the eligibility of many adults enrolled in Medicaid more frequently — at least twice a year.
“I’m concerned that states are doing unnecessary checks that create a burden for some enrollees who will lose their health coverage when they shouldn’t,” Cuello said. “This is going to be a lot of work for CMS and the states for very little pay.”
Cuello said the effort may have “greater political value than its actual value.”
Brandon Cwalina, a spokesman for the Pennsylvania Department of Human Services, which administers Medicaid in the state, said the state already requires every Medicaid applicant to verify their citizenship or, where applicable, eligible immigration status.
However, he said, the directive issued by CMS “is a new process, and DHS is carefully reviewing the list to take appropriate action.”
Oz did not name Pennsylvania, which Trump won in 2024, in his post.
If a legal resident does not have a Social Security number, the state confirms their legal status by checking a Homeland Security database, as well as checking specific immigration documents, he explained.
Other state Medicaid agencies said they also need to band together before contacting enrollees.
“Our teams have just received this notice and are working on a process by which we will conduct these reviews,” Jennifer Strohecker, then Utah’s Medicaid director, told a state advisory board in August.
Renuka Rayasam and Rae Ellen Bichell contributed reporting.
