Trump’s HHS orders state Medicaid programs to help find undocumented immigrants

The Trump administration has ordered states to examine some Medicaid enrollees to determine whether they are ineligible because of their immigration status, with five states reporting that they collectively received more than 170,000 names, an “unprecedented” move by the federal government that implicates the state-federal health program in the president’s immigration crackdown.

Supporters say such pressures burden states with duplicate verifications and could lead to loss of insurance simply for missing filing deadlines. However, Centers for Medicare and Medicaid Services Administrator Mehmet Oz wrote in an Oct. 31 post on the X social media platform that more than $1 billion in “federal taxpayer dollars have been spent to fund Medicaid for undocumented immigrants” in five states and Washington, D.C.

Total Medicaid spending in fiscal year 2024 exceeded $900 billion.

It is not clear from Oz’s statement or the accompanying video how long the expenses occurred, and CMS spokespeople did not immediately respond to questions either about an earlier version of this article or after Oz’s statement was published.

Only U.S. citizens and certain legal immigrants are eligible for Medicaid, which covers low-income people and people with disabilities, as well as a closely related children’s health insurance program. People without legal status are not eligible for federally funded health insurance, including Medicaid, Medicare, and plans available in Affordable Care Act marketplaces.

At least one state said it disagreed with Oz’s comments.

“Our payments for undocumented insurance are consistent with state and federal law,” said Marc Williams, spokesman for the Colorado Department of Health Care Policy and Financing, which administers the state’s Medicaid program. “The $1.5 million figure cited by federal leaders today is based on flawed preliminary findings and has been disproved by corroborating data from experts in our Department.”

He added: “It is disappointing that the administration is announcing this number as final when it is clearly an inflated figure and the talks are largely in the education and discussion stage.”

In August, CMS began sending states the names of Medicaid enrollees the agency suspects may be ineligible, requiring state Medicaid agencies to check their immigration status.

In October, KFF Health News contacted Medicaid agencies in 10 states. Five gave the approximate number of names they received from the Trump administration, expecting it to be more: 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 countries declined to comment further. Medicaid agencies in California, Florida, Georgia, New York and South Carolina declined to say how many names they were ordered to review or did not respond.

Oz said in his post

“We notified the states and many of them started giving refunds,” he said. – But what if we never asked about it?

Washington’s Medicaid director, Melisa Byrd, said CMS has identified administrative expenses under the district program, which covers people regardless of immigration status, that should not be billed to the federal government, and her agency has already fixed some of those areas. “We run a large program that is very complex, and when mistakes or mistakes happen, we fix them,” she said.

The program plans to reimburse CMS $654,014 by mid-November.

All five states and Washington, D.C., are led by Democrats, and President Donald Trump did not win any of them in the 2024 election.

In recent days, Deputy Secretary of Health and Human Services Jim O’Neill began posting photos on Page X of people he believes are convicted felons living in the U.S. without authorization and who have received Medicaid benefits.

O’Neill could not be reached for comment.

“We’re very concerned because, frankly, it seems like a waste of state resources and furthers the administration’s anti-immigration agenda,” said Ben D’Avanzo, senior health strategist at the advocacy group National Immigration Law Center. “This replicates what states have already done,” he said.

As part of the administration’s crackdown on people staying in the U.S. without authorization, in February, President Donald Trump ordered federal agencies to take action to ensure they do not obtain benefits in violation of federal law.

In June, advisers to Secretary of Health and Human Services Robert F. Kennedy Jr. ordered CMS to share information about Medicaid enrollees with the Department of Homeland Security, prompting some states to file a lawsuit concerned that the administration could use the information in a deportation campaign against unauthorized residents.

In August, a federal judge ordered HHS to stop sharing information with immigration authorities.

State Medicaid agencies use databases maintained by the Social Security Administration and the Department of Homeland Security to verify the immigration status of enrollees.

If states have to go back to individuals to re-verify their citizenship or immigration status, it could cause some people to fall off the list unnecessarily – for example, if they don’t receive a letter requesting documents or miss the deadline to respond.

“I’m not sure the evidence shows there’s really a need for this additional review,” said Marian Jarlenski, a professor of health policy at the University of Pittsburgh School of Public Health.

Oz made it clear that the Trump administration disagreed.

“Whether intentional or not, states’ actions highlight a terrifying reality: American taxpayers are footing the bill for Medicaid coverage for illegal immigrants, despite many Democrats and the media insisting otherwise,” 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 cannot be confirmed in federal databases. “We expect countries to take swift action and monitor progress monthly,” the agency said.

Leonardo Cuello, a research professor at the Center for Children and Families at Georgetown University, called CMS’s finding order “unprecedented” in the 60-year history of the Medicaid program.

He said the federal government may have been unable to verify the immigration status of some people because of misspelled or outdated names, such as when a beneficiary is identified by her maiden name rather than her marital name. Names may also include people supported by Emergency Medicaid, a program that covers the cost of emergency hospital services, including labor and delivery, for people regardless of immigration status.

“CMS conducts meaningless immigration status checks on people whose hospital bills were paid by Emergency Medicaid,” Cuello said.

Oz noted in his post 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 state taxes as long as federal tax dollars are not used.”

All of the states Oz mentioned run their own such programs.

The verification checks add an additional burden to state Medicaid agencies, which are already busy preparing to implement the tax and policy bill Trump signed in July. The measure, which Republicans are calling the One Big Beautiful Bill Act, makes many changes to Medicaid, including adding a work requirement in most states starting in 2027. The law also requires most states to check multiple adult Medicaid enrollees for eligibility more often – at least twice a year.

“I am concerned that states may conduct unnecessary audits that will burden some enrollees who will lose health insurance and who should not,” Cuello said. “It will be a lot of work for CMS and the states for very little money.”

Cuello said the effort may have “more political value than real value.”

Brandon Cwalina, a spokesman for the Pennsylvania Department of Human Services, which administers the state’s Medicaid program, said the state already requires anyone applying for Medicaid to verify their citizenship or, if applicable, qualifying immigration status.

However, he said, the directive issued by CMS “constitutes a new process and DHS is carefully reviewing the list to take appropriate action.”

Oz did not mention Pennsylvania, which Trump won in 2024, in his post.

If a legal resident does not have a Social Security number, the state confirms his legal status by checking a Department of Homeland Security database as well as verifying certain immigration documents, he said.

Other state Medicaid agencies said they also needed to regroup before contacting enrollees.

“Our teams just received this notification and are working on the process by which we will conduct these assessments,” Jennifer Strohecker, then Utah’s director of Medicaid, told the state advisory board in August.