Trump administration orders state Medicaid programs to help identify illegal immigrants

President Donald Trump’s administration has ordered states to investigate beneficiaries of Medicaid — the program that covers low-income people or people with disabilities — to see if they meet eligibility requirements based on their immigration status.

So far, five states have reported that they have already received, in total, more than 170,000 names, an unprecedented action by the federal government, which means involving the federal health program at the state level in the president’s anti-immigration campaign.

Immigrant rights advocates warn that this decision places an additional burden on states by having to repeat checks and could result in some people losing their health coverage simply for not submitting documents on time.

However, Dr. Mehmet Oz, director of the Centers for Medicare and Medicaid Services (CMS), said in a post on the social media platform

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

Neither Oz’s statement nor the accompanying video explained the period over which these expenses were incurred, and CMS spokesmen did not immediately respond to requested questions.

Federal rules limit eligibility for Medicaid and the Children’s Health Insurance Program (CHIP) to U.S. citizens and certain U.S. citizens. immigrants Who legally reside in the country.

People without legal immigration status cannot obtain any federally funded health coverage, including Medicaid, Medicare, and plans purchased through the insurance exchanges created by the Affordable Care Act (ACA).

Several states said they disagreed with Oz’s statements.

“Our payments to cover unenrolled people are consistent with state and federal laws,” said Mark 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 an inaccurate preliminary finding and has been refuted by statements from our Department’s experts.”

He added: “It is disappointing for the administration to announce this number as final, which is clearly exaggerated, and the talks are still in the information and discussion stage.”

Illinois Medicaid officials strongly criticized the CMS chief’s comments.

“Once again, the Trump administration is spreading misinformation about the routine use of Medicaid funds,” said Melissa Cola, Illinois Medicaid spokeswoman.

“This is not a reality show, nor is there a conspiracy to circumvent federal law and provide Medicaid coverage to people who do not qualify,” Cola said. “Dr. Oz should stop promoting conspiracy theories and focus on improving health care for Americans.”

The Washington State Health Care Authority, which administers the state’s Medicaid program, was also frank. “The numbers posted by Dr. Oz on social media are inaccurate,” said department spokeswoman Rachel Alongi. “We were very surprised to see Dr. Oz participate, especially since we continue to work in good faith with the Centers for Medicare & Medicaid Services (CMS) to answer their questions and remove any confusion.”

In August, CMS began sending names of Medicaid enrollees to states who the agency suspected might be ineligible, requiring state program agencies to verify their immigration status.

In October, KFF Health News contacted 10 Medicaid agencies in the state. Five of them gave rough numbers for the names they have received from the Trump administration so far, but assume more will come: Utah has received 8,000 names; Colorado, 45,000; Pennsylvania, 34,000; Ohio, 61,000; and Texas 28,000.

Currently, there are more than 70 million people enrolled in Medicaid.

Most of those countries declined to comment further. Five others — California, New York, Georgia, Florida and South Carolina — declined to say how many names they were asked to review, or did not respond at all.

Oz claimed in his book

“We have informed the states and many of them have already started refunding the money,” he said. “But what would have happened if we had never asked?”

Melissa Byrd, Washington, D.C.’s Medicaid director, said CMS has determined administrative expenses for the region’s program, which covers people regardless of their immigration status, should not be sent to the federal government, and that her agency has already corrected some of those errors.

“We run a very large and complex program, and when mistakes happen, we correct them,” he said. The program plans to repay CMS $654,014 by mid-November.

Democrats govern all five states, plus Washington, D.C., and President Donald Trump did not win any of them in the 2024 election.

In recent days, Under Secretary of Health and Human Services Jim O’Neill Publishing has begun On the social platform

O’Neill could not be reached for comment.

“We’re very concerned because this, frankly, seems like a waste of state resources and advances the administration’s anti-immigrant agenda,” said Ben D’Avanzo, senior health policy strategist at the National Immigration Law Center, an immigrant rights advocacy organization. “This replicates what countries are already doing,” he added.

As part of a crackdown on people without legal status, the president in February ordered federal agencies to ensure that people without legal status do not receive benefits that violate federal law.

In June, Health and Human Services (HHS) Secretary Robert F. Kennedy, CMS shares information about people enrolled in Medicaid with the Department of Homeland Security (DHS). This led to a lawsuit from several states concerned that this information would be used in deportation campaigns.

In August, a federal judge ordered the Department of Health and Human Services to do so Stop sharing That information is with the immigration authorities.

State Medicaid agencies typically use databases managed by Social Security, the Department of Homeland Security, and other government agencies to verify the immigration status of applicants.

If states have to recontact enrollees to double-check their immigration or citizenship status, some may unjustifiably lose their coverage, for example, if they do not see the letter requesting documents or do not respond in a timely manner.

“I’m not sure there’s enough evidence to warrant this additional verification,” said Marian Jarlinsky, a professor of health policy at the University of Pittsburgh School of Public Health.

Oz explained that the Trump administration does not agree with this.

In an August statement, CMS explained that it is asking states to verify the eligibility of people whose immigration status cannot be confirmed through federal databases. “We expect countries to act quickly and will monitor progress month by month,” the agency said.

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

He said the federal government may not have been able to verify the immigration status of some people because their names were misspelled or outdated, such as when a beneficiary is listed in her maiden name instead of her married name.

The lists may also include people who received assistance through Emergency Medicaid, a program that covers expenses for emergency hospital services, including delivery and labor care, regardless of immigration status.

“CMS conducts futile immigration status reviews of people whose medical expenses are covered by Emergency Medicaid,” Coelho explained.

Oz noted in his post that federal law “allows states to use Medicaid funds for emergency treatments, regardless of patients’ citizenship or immigration status,” and that states can “legally establish Medicaid programs for illegal immigrants using their state taxes, as long as no federal funds are used.”

All the countries mentioned by Oz They run their own programs Of this kind.

These reviews impose an additional burden on government Medicaid agencies, which are already busy preparing to implement the tax and spending law that Trump signed in July.

The bill, which Republicans called the “big, beautiful bill,” makes several changes to Medicaid, including imposing work requirements in most states starting in 2027. It also requires them to review enrollees’ eligibility at least twice a year.

“I fear that states will conduct unnecessary verifications that will place a burden on some beneficiaries, who will lose health coverage when they should not,” Coelho explained. “This will require a lot of work for CMS and states, with very few real results.”

Since the new policy allows the agency to release data publicly, Coelho said the effort has more political value than practical value.

The state already requires each applicant to prove their citizenship or, when applicable, their immigration status, said Brandon Qualina, a spokesman for the Pennsylvania Department of Social Services, which administers Medicaid.

He explained: “But the list of names and instructions issued by CMS last month constitutes a new procedure, and the administration is carefully reviewing that list to take appropriate action.”

In his post, Oz did not mention Pennsylvania, a state that Trump won in 2024.

When a legal resident does not have a Social Security number, the state verifies his or her status using the Department of Homeland Security’s database, in addition to reviewing specific immigration documents, he added.

Other state Medicaid agencies said they had not yet begun contacting enrollees.

“We are developing a procedure to conduct these reviews,” Jennifer Stroecker, Utah’s Medicaid director, said during an August meeting with a state advisory board.

Renuka Rayasam and Rae Ellen Bischel contributed to this article.