Phil Galewitz, KFF Health News
The Trump administration has ordered states to analyze sure people enrolled in Medicaid to find out whether or not they’re ineligible due to their immigration standing, with 5 states reporting they’ve collectively acquired greater than 170,000 names — an “unprecedented” step by the federal authorities that ensnares the state-federal well being program within the president’s immigration crackdown.
Advocates say the push burdens states with duplicative verification checks and could lead on folks to lose protection only for lacking paperwork deadlines. But the administrator of the Centers for Medicare & Medicaid Services, Mehmet Oz, mentioned in a put up on the social platform X on Oct. 31 that greater than $1 billion “of federal taxpayer dollars were being spent on funding Medicaid for illegal immigrants” in 5 states and Washington, D.C.
Medicaid’s general spending topped $900 billion in fiscal yr 2024.
It wasn’t clear from Oz’s assertion or an accompanying video over what interval the spending occurred, and CMS spokespeople didn’t instantly reply to questions, both for an earlier model of this text or after Oz’s assertion was posted.
Only U.S. residents and a few lawfully current immigrants are eligible for Medicaid, which covers low-income and disabled folks, and the carefully associated Children’s Health Insurance Program. Those with out authorized standing are ineligible for federally funded well being protection, together with Medicaid, Medicare, and plans by means of the Affordable Care Act marketplaces.
Several states disputed Oz’s feedback.
“Our payments for coverage of undocumented individuals are in accordance with state and federal laws,” mentioned Marc Williams, a spokesperson for Colorado’s Department of Health Care Policy & Financing, which administers the state’s Medicaid program. “The $1.5 million number referenced by federal leaders today is based on an incorrect preliminary finding, and has been refuted with supporting data by our Department experts.”
He added: “It is disappointing that the administration is announcing this number as final when it is clearly overstated and the conversations are very much in the education and discussion phase.”
Illinois Medicaid officers blasted Oz’s feedback.
“Once again, the Trump administration is spreading misinformation about standard uses of Medicaid dollars,” mentioned Illinois Medicaid spokesperson Melissa Kula. “This is not a reality show, and there is no conspiracy to circumvent federal law and provide ineligible individuals with Medicaid coverage. Dr. Oz should stop pushing conspiracy theories and focus on improving health care for the American people.”
The Washington State Health Care Authority, which runs the state’s Medicaid program, was additionally blunt.
“The numbers Dr. Oz posted on social media today are inaccurate,” mentioned spokesperson Rachelle Alongi. “We were very surprised to see Dr. Oz’s post, especially considering we continue to work with CMS in good faith to answer their questions and clear up any confusion.”
In August, CMS started sending states the names of individuals enrolled in Medicaid that the company suspected may not be eligible, demanding state Medicaid companies verify their immigration standing.
KFF Health News in October reached out to Medicaid companies in 10 states. Five offered the approximate variety of names they’d acquired from the Trump administration, with expectations of extra to come back: Colorado had been given about 45,000 names, Ohio 61,000, Pennsylvania 34,000, Texas 28,000, and Utah 8,000. More than 70 million persons are enrolled in Medicaid.
Most of these states declined to remark additional. Medicaid companies in California, Florida, Georgia, New York, and South Carolina refused to say what number of names they had been ordered to assessment or didn’t reply.
Oz mentioned in his X put up that California had misspent $1.3 billion on look after folks not eligible for Medicaid, whereas Illinois spent $30 million, Oregon $5.4 million, Washington state $2.4 million, Washington, D.C., $2.1 million, and Colorado $1.5 million.
“We notified the states, and many have begun refunding the money,” he mentioned. “But what if we had never asked?”
Washington, D.C.’s Medicaid director, Melisa Byrd, mentioned CMS had recognized administrative bills for the district program that covers folks no matter immigration standing that ought to not have been billed to the federal authorities and her company has already mounted a few of these areas. “We run a big program that is very complex and when mistakes or errors happen, we fix them,” she mentioned.
The program plans to pay $654,014 again to CMS by mid-November.
All 5 states, plus Washington, D.C., are led by Democrats, and President Donald Trump didn’t win any of them within the 2024 election.
In current days, Deputy Health and Human Services Secretary Jim O’Neill began posting pictures on X of individuals he mentioned are convicted criminals residing within the U.S. with out authorization who had acquired Medicaid advantages.
O’Neill couldn’t be reached for remark.
“We are very concerned because this seems, frankly, to be a waste of state resources and furthers the administration’s anti-immigrant agenda,” mentioned Ben D’Avanzo, senior well being advocacy strategist with the National Immigration Law Center, an advocacy group. “This duplicates what states already do,” he mentioned.
As a part of the administration’s crackdown on folks within the U.S. with out authorization, President Donald Trump in February directed federal companies to take motion to make sure they aren’t acquiring advantages in violation of federal legislation.
In June, advisers to Health and Human Services Secretary Robert F. Kennedy Jr. ordered CMS to share details about Medicaid enrollees with the Department of Homeland Security, drawing a lawsuit by some states alarmed that the administration would use the knowledge for its deportation marketing campaign in opposition to unauthorized residents.
In August, a federal choose ordered HHS to stop sharing the information with immigration authorities.
State Medicaid companies use databases maintained by the Social Security Administration and Department of Homeland Security to confirm enrollees’ immigration standing.
If states want to return to people to reverify their citizenship or immigration standing, it could lead on some to fall off the rolls unnecessarily — for instance, in the event that they don’t see a letter requesting paperwork or fail to fulfill a deadline to reply.
“I am not sure that evidence suggests there really is a need for this” additional verification, mentioned Marian Jarlenski, a well being coverage professor on the University of Pittsburgh School of Public Health.
Oz made clear that the Trump administration disagrees.
“Whether willful or not, the states’ conduct highlights a terrifying reality: American taxpayers have been footing the bill for illegal immigrants’ Medicaid coverage, despite many Democrats and the media insisting otherwise,” Oz mentioned in his X put up.
In an August press launch, CMS mentioned it will ask states to confirm eligibility for enrollees whose immigration standing couldn’t be confirmed by way of federal databases. “We expect states to take quick action and will monitor progress on a monthly basis,” the company mentioned.
Leonardo Cuello, a analysis professor at Georgetown University’s Center for Children and Families, referred to as the CMS order to states “unprecedented” within the Medicaid program’s 60-year historical past.
He mentioned the federal authorities might have been unable to confirm sure people’ immigration standing as a result of names had been misspelled or outdated, comparable to when a beneficiary is recognized by their maiden as an alternative of married identify. The names may additionally embrace folks helped by Emergency Medicaid, a program that covers the price of hospital emergency companies, together with labor and supply, for folks no matter immigration standing.
“CMS is conducting pointless immigration status reviews for people whose hospital bills were paid by Emergency Medicaid,” Cuello mentioned.
Oz famous in his put up that federal legislation “does permit states to use Medicaid dollars for emergency treatment, regardless of patients’ citizenship or immigration status,” and that states can “legally build Medicaid programs for illegal immigrants using their own state tax dollars, so long as no federal tax dollars are used.”
The states Oz talked about all run their own such packages.
The verification checks create an added burden for state Medicaid companies which are already busy making ready to implement the tax and coverage legislation Trump signed in July. The measure, which Republicans name the One Big Beautiful Bill Act, makes many modifications to Medicaid, together with including a piece requirement in most states beginning by 2027. The legislation additionally requires most states to extra ceaselessly verify the eligibility of many grownup Medicaid enrollees — no less than twice a yr.
“I fear states may do unnecessary checks that create a burden for some enrollees who will lose health coverage who should not,” Cuello mentioned. “It’s going to be a whole lot of work for CMS and states for very little pay dirt.”
Cuello mentioned the trouble might have “greater political value than actual value.”
Brandon Cwalina, a spokesperson for the Pennsylvania Department of Human Services, which runs Medicaid within the state, mentioned the state already requires each Medicaid applicant to confirm their citizenship or, the place relevant, their eligible immigration standing.
However, he mentioned, the directive issued by CMS “constitutes a new process, and DHS is carefully reviewing the list in order to take appropriate actions.”
Oz didn’t identify Pennsylvania, which Trump received in 2024, in his put up.
If a lawful resident doesn’t have a Social Security quantity, the state confirms their authorized standing by checking a database from Homeland Security, in addition to verifying particular immigration paperwork, he mentioned.
Other state Medicaid companies mentioned additionally they wanted to regroup earlier than reaching out to enrollees.
“Our teams just received this notice and are working through a process by which we will perform these reviews,” Jennifer Strohecker, then Utah’s Medicaid director, instructed a state advisory board in August.
Renuka Rayasam and Rae Ellen Bichell contributed reporting.
KFF Health News is a nationwide newsroom that produces in-depth journalism about well being points and is likely one of the core working packages at KFF—an impartial supply of well being coverage analysis, polling, and journalism. Learn extra about KFF.
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