Angela Hart and Devi Shastri, The Associated Press
SACRAMENTO, Calif. — The Trump administration is taking its immigration crackdown to the well being care security internet, launching Medicaid spending probes in not less than six Democratic-led states that present complete well being protection to poor and disabled immigrants dwelling within the U.S. with out everlasting authorized standing.
The Centers for Medicare & Medicaid Services is scouring funds masking well being take care of immigrants with out authorized standing to make sure there isn’t any waste, fraud, or abuse, in response to public information obtained by KFF Health News and The Associated Press. While acknowledging that states can invoice the federal authorities for Medicaid emergency and being pregnant take care of immigrants with out authorized standing, federal officers have despatched letters notifying state well being companies in California, Colorado, Illinois, Minnesota, Oregon, and Washington that they’re reviewing federal and state funds for medical companies resembling pharmaceuticals and specialty care.
The federal company advised the states it’s reviewing claims as a part of its dedication to take care of Medicaid’s fiscal integrity. California is the most important goal after the state self-reported overcharging the federal authorities for well being care companies delivered to immigrants with out authorized standing, decided to be not less than $500 million, spurring the specter of a lawsuit.
“If CMS determines that California is using federal money to pay for or subsidize healthcare for individuals without a satisfactory immigration status for which federal funding is prohibited by law,” in response to a letter dated March 18, “CMS will diligently pursue all available enforcement strategies, including, consistent with applicable law, reductions in federal financial participation and possible referrals to the Attorney General of the United States for possible lawsuit against California.”
The investigations come because the White House and a Republican-controlled Congress slashed taxpayer spending on immigrant well being care through cuts in President Donald Trump’s spending-and-tax legislation handed this summer time. The administration can also be pushing people dwelling within the U.S. with out authorization off Medicaid rolls. Health coverage consultants say these strikes may hamper care and go away security internet hospitals, clinics, and different suppliers financially vulnerable. Some Democratic-led states — California, Illinois, and Minnesota — have already needed to finish or slim down their Medicaid packages for immigrants because of ballooning prices. Colorado can also be contemplating cuts because of price overruns.
At the identical time, 20 states are pushing again on Trump’s immigration crackdown by suing the administration for handing over Medicaid data on thousands and thousands of enrollees to deportation officers. A federal decide temporarily halted the transfer. California’s lawyer normal, Rob Bonta, who led that problem, says the Trump administration is launching a political assault on states that embrace immigrants in Medicaid packages.
“The whole idea that there’s waste, fraud, and abuse is contrived,” Bonta mentioned. “It’s manufactured. It’s invented. It’s a catchall phrase that they use to justify their predetermined anti-immigrant agenda.”
Trump Targets Immigrants
Immigrants missing everlasting authorized standing aren’t eligible to enroll in complete Medicaid protection. However, states invoice the federal authorities for emergency and being pregnant care supplied to anybody.
Fourteen states and Washington, D.C., expanded their Medicaid packages with their very own funds to cowl low-income kids with out authorized standing. Seven of these states, plus Washington, D.C., have additionally supplied full-scope protection to some grownup immigrants dwelling within the nation with out authorization.
The Trump administration seems to be focusing on solely states with full Medicaid protection for each children and adults with out authorized standing. Utah, Massachusetts, and Connecticut, which offer Medicaid protection only to immigrant children, haven’t obtained letters, for example. CMS declined to offer a full listing of states it’s focusing on.
Federal officers say it’s their authorized proper and accountability to scrutinize states for misspending on immigrant well being protection and are taking “decisive action to stop that.”
“It is a matter of national concern that some states have pushed the boundaries of Medicaid law to offer extensive benefits to individuals unlawfully present in the United States,” CMS spokesperson Catherine Howden mentioned concerning the company’s probe of chosen states. The oversight is meant to “ensure federal funds are reserved for legally eligible individuals, not for political experiments that violate the law,” she mentioned.
Health coverage researchers and economists say offering Medicaid protection to immigrants for preventive companies and therapy of power well being circumstances staves off extra expensive take care of sufferers down the highway. It additionally tamps down insurance coverage premium will increase and the quantity of uncompensated take care of hospitals and clinics.
Francisco Silva, president and CEO of the California Primary Care Association, mentioned the Trump administration is threatening to drive up well being care prices and make it harder to entry care.
“The impact is emergency rooms would get so crowded that ambulances have to be diverted away and people in a real emergency can’t get into the hospital, and public health threats like disease outbreaks,” Silva mentioned.
California has taken a health-care-for-all strategy, offering protection to 1.6 million immigrants with out authorized standing. The enlargement, which was rolled out from 2016 to 2024, is estimated to price $12.4 billion this yr. Of that, $1.3 billion is paid by the federal authorities for emergency and pregnancy-related care.
As California rolled out its enlargement, the state erroneously billed the federal authorities for care supplied to immigrants with out authorized standing — particulars that haven’t beforehand been reported and that former state officers shared with KFF Health News and the AP. The state improperly billed for companies resembling psychological well being and habit companies, pharmaceuticals, and dental care.
Jacey Cooper, who served as California’s Medicaid director from 2020 to 2023, mentioned she found the error and reported it to federal regulators. Cooper mentioned the state had been working to pay again not less than $500 million recognized by the federal authorities.
“Once I identified the problem, I thought it was really important to report it and we did,” Cooper mentioned. “We take waste, fraud, and abuse very seriously.”
It’s not clear whether or not that cash has been repaid. The state’s Medicaid company says it doesn’t know the way CMS calculated the overpayments or “what is included in that amount, what time period it covers, and if or when it was collected,” mentioned spokesperson Tony Cava.
California has an enormously difficult Medicaid program: It serves the biggest inhabitants within the nation — almost 15 million people — with a price range of almost $200 billion this fiscal yr.
Matt Salo, a nationwide Medicaid skilled, mentioned a lot of these errors occur in states all through the nation as a result of this system is rife with overlapping federal and state guidelines. Salo and different coverage analysts agreed that states have the authority to manage their Medicaid packages as they see match and root out misuse of federal funds.
And Michael Cannon, director of well being coverage research on the libertarian Cato Institute, mentioned the Trump administration’s actions “persecute a minority that’s unpopular with the powers that be.”
“The Trump administration cannot maintain that this effort has anything to do with maintaining the fiscal integrity of the Medicaid program,” Cannon mentioned. “There are so much bigger threats to Medicaid’s fiscal integrity, that that argument just doesn’t wash.”
Immigrants’ Medicaid Under Attack
National Republicans have focused well being spending on immigrants in numerous methods. The GOP spending legislation, which Trump calls the “One Big Beautiful Bill,” will decrease reimbursement to states around the country in October 2026. In California, for instance, federal reimbursement for immigrants with out authorized standing will go to 50% for emergency companies, down from 90% for the Medicaid enlargement inhabitants, in response to Cava.
The Trump administration can also be scaling again Medicaid protection to immigrants with short-term authorized standing who have been beforehand coated and announced in August that it could present states with month-to-month studies mentioning enrollees whose authorized standing couldn’t be confirmed by the Department of Homeland Security.
“Every dollar misspent is a dollar taken away from an eligible, vulnerable individual in need of Medicaid,” CMS Administrator Mehmet Oz mentioned in an announcement. “This action underscores our unwavering commitment to program integrity, safeguarding taxpayer dollars, and ensuring benefits are strictly reserved for those eligible under the law.”
States underneath overview say they’re following the legislation.
“Spending money on a congressionally authorized medical benefit program that helps people get emergency treatments for cancer, dialysis, and anti-rejection medications for organ transplants is decidedly not waste, fraud and abuse,” mentioned Mike Faulk, deputy communications director for Washington state Attorney General Nick Brown.
Records present Washington Medicaid officers have been inundated with questions from CMS about federal funds masking emergency and being pregnant take care of immigrants with out authorized standing.
Emails present Illinois officers met with CMS and sought an extension to share its information. CMS denied that request and federal regulators advised the state that its funding could possibly be withheld.
“Thousands of Illinois residents rely on these programs to lawfully seek critical health care without fear of deportation,” mentioned Melissa Kula, a spokesperson for the Illinois Department of Healthcare and Family Services, noting that any federal lower can be “impossible” for the state to backfill.
Shastri reported from Milwaukee.
The Associated Press Health and Science Department receives help from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely answerable for all content material.
This article was produced by KFF Health News, which publishes California Healthline, an editorially impartial service of the California Health Care Foundation.
